Background: Chronic liver disease (CLD) has a number of systemic manifestations, one of which is cardiac autonomic dysfunction (CAD), and the latter can cause poor outcomes, including arrhythmia, cardiac failure, and sudden cardiac death. An important factor that contributes to these complications is the autonomic imbalance experienced between the sympathetic and the parasympathetic nerve systems. This research was determined to study the rates of CAD among CLD patients and determine the extent of CAD, as well as the association of CAD with the severity of liver disease. Methods: This is a cross-sectional research study that incorporates 196 CLD patients at Sri Aurobindo Medical College and PG Institute, Indore, India, performed between June 2023 and November 2024. The cardiac autonomic function has been measured through Ewing battery of tests which assessed parasympathetic and sympathetic activities. Child-Pugh classification was used to analyze the severity of liver disease. Raw data were processed with the use of descriptive and statistical methods with the aim to analyze the interconnections between CAD and liver functioning. Results: The results of the study reported that 72.4 percent of the patients had some amount of CAD whereby 27.6 percent of the patients had normal autonomic moderate, 31.6 percent had early CAD, and 24.5 percent portrayed definite CAD, there was also 16.3 percent of the patients who had severe CAD. They found a strong correlation between the degree of CAD and the Child-Pugh classification (p < 0.0001) such that there was a gradual rise in the magnitude of autonomic dysfunction with the progression of liver disease. There was a decrease in Valsalva ratio with increasing severity of the liver disease (p < 0.0001). Conclusion: The presence of cardiac autonomic dysfunction in the CLD patients is common and with the advances of consumption of liver disease, the condition deteriorates. The tests conducted by Ewing were very useful in establishing autonomic dysfunction that can be used in early diagnosis and stratification of risks of cardiac complications in patients of CLD.

Chronic Liver Disease, Cardiac Autonomic Disorder, Child-Pugh Score, Autonomic Nervous System, Ewing Battery of Tests