Liver disease severity is poorly related to the presence of restless leg syndrome in patients with cirrhosis.

Abstract

Restless leg syndrome (RLS) has been reported to be common in patients with cirrhosis. The relation of RLS with severity of liver disease is, however, unclear. We studied the association between occurrence of RLS and severity of cirrhosis. Single centre, prospective, observational study. Adult patients with cirrhosis and relatively stable clinical condition and no associated neurological condition were prospectively studied. Severity of liver disease was graded as Child-Turcotte-Pugh (CTP) class A, B or C; using Model for End-Stage Liver Disease (MELD) score; and as a binary variable (compensated or decompensated disease). Each subject underwent an initial screening for RLS, followed by a re-evaluation by an independent neurologist to confirm the diagnosis, using the International RLS Diagnostic Criteria. In patients with RLS, its severity was assessed using a validated Hindi translation of the International RLS severity (IRLS) scoring system. Data for categorical variables were expressed as proportions and compared using chi-squared test, and those for numerical variables were expressed as median and range, and compared using Wilcoxon rank sum test. Among the 356 patients with cirrhosis studied (median [range] age: 48 [18-83] years; 241 [67.7%] male; CTP A/163, B/172, C/21; MELD 11 [6-41]; decompensated 51.7%), 36 (10.1%) had RLS. RLS severity was mild (1), moderate (15), severe (19) or very severe (1). Compared to those without RLS, patient with RLS had a lower MELD score (9 [6-25] versus 11 [6-41], P = 0.04), and a comparable distribution of CTP classes and frequency of decompensated liver disease. The prevalence and severity of RLS were not different between those with compensated and those with decompensated cirrhosis. In the Indian population, RLS is common in patients with cirrhosis. Its occurrence did not show any increase with the severity of liver disease.