Prevalence and morbidity associated with muscle cramps in patients with cirrhosis

Hemant Chatrath, Suthat Liangpunsakul, Marwan Ghabril, Julie Otte, Naga Chalasani, Raj Vuppalanchi, Hemant Chatrath, Suthat Liangpunsakul, Marwan Ghabril, Julie Otte, Naga Chalasani, Raj Vuppalanchi

Abstract

Purpose: Patients with cirrhosis often experience muscle cramps with varying severity. We investigated the factors associated with the prevalence and morbidity associated with muscle cramps.

Methods: A total of 150 adult patients with cirrhosis were enrolled consecutively. Cramp questionnaire with visual analogue scale for pain, Chronic Liver Disease Questionnaire (CLDQ), and blood for measurement of 25-(OH) vitamin D levels were obtained after informed consent.

Results: A total of 101 patients (67%) reported muscle cramps in the preceding 3 months. Patients with cramps had significantly lower serum albumin (3.1±0.6 g/dL vs 3.3±0.7 g/dL, P=.04) and CLDQ scores (107±37 vs 137±34, P<.0001) compared with those without cramps. The median composite symptom score, defined as product of frequency and severity of cramps, in the study cohort was 12 with a range of 0.3 to 200. There were no clinical or biochemical predictors for occurrence of any cramps or severe cramps (composite symptom score>12). Muscle cramps (P<.001) and hepatic encephalopathy (P=.009) were associated independently with decreased CLDQ scores. Vitamin D deficiency was seen in 66% of the study cohort, but the serum 25-(OH) vitamin D levels were not significantly different between patients with and without cramps (18.0±8.9 ng/mL vs 19.6±9.5 ng/mL, P=.49).

Conclusions: Muscle cramps are associated with significantly diminished quality of life in patients with cirrhosis. More research is needed to better understand their mechanism to develop effective treatment.

Conflict of interest statement

Conflict of Interest: None.

Copyright © 2012 Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Cramp questionnaire to capture description of muscle cramps (onset, precipitating events, frequency, duration, relief, and localization) and severity of pain by visual analogue scale for pain (Wong-Baker FACES Pain Rating Scale).
Figure 2
Figure 2
Characteristics of muscle cramps as reported by the patients. A, Frequency of muscle cramps as reported by the patients (n = 101). B, Self-reported severity of cramps using visual analogue scale for pain by Wong-Baker FACES Pain Rating Scale in patients with cramps.
Figure 3
Figure 3
Significant negative correlation between the CSS and the CLDQ. CLDQ = Chronic Liver Disease Questionnaire; CSS = composite symptom score.

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