The Association Between the Serum Sodium Level and the Severity of Complications in Liver Cirrhosis
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background/Aims: Dilutional hyponatremia associated with liver cirrhosis is caused by impaired free water clearance. Several studies have shown that serum sodium levels correlate with survival in cirrhotic patients. Little is known, however, regarding the relationship between the degree of dilutional hyponatremia and development of cirrhotic complications. The aim of this study was to evaluate the association between the serum sodium level and the severity of complications in liver cirrhosis. Methods: Data of inpatients with cirrhotic complications were collected retrospectively. The serum sodium levels and severity of complications of 188 inpatients were analyzed. Results: The prevalence of dilutional hyponatremia, classified as serum sodium concentrations of ≤135 mmol/ℓ, ≤130 mmol/ℓ, and ≤125 mmol/ℓ, were 20.8%, 14.9%, and 12.2%, respectively. The serum sodium level was strongly associated with the severity of liver function impairment as assessed by Child-Pugh and MELD scores (p<0.0001). Even a mild hyponatremia with a serum sodium concentration of 131-135 mmol/ℓ was associated with severe complications. Sodium levels less than 130 mmol/ℓ indicated the existence of massive ascites (OR, 2.685; CI, 1.316-5.477; p=0.007), grade III or higher hepatic encephalopathy (OR, 5.891; CI, 1.490-23.300;p=0.011), spontaneous bacterial peritonitis (OR, 2.562; CI, 1.162-5.653; p=0.020), and hepatic hydrothorax (OR,5.723; CI, 1.889-17.336; p=0.002). Conclusions: Hyponatremia, especially serum levels ≤130 mmol/ℓ, may indicate the existence of severe complications associated with liver cirrhosis.
Abstract
Background/Aims: Dilutional hyponatremia associated with liver cirrhosis is caused by impaired free water clearance. Several studies have shown that serum sodium levels correlate with survival in cirrhotic patients. Little is known, however, regarding the relationship between the degree of dilutional hyponatremia and development of cirrhotic complications. The aim of this study was to evaluate the association between the serum sodium level and the severity of complications in liver cirrhosis. Methods: Data of inpatients with cirrhotic complications were collected retrospectively. The serum sodium levels and severity of complications of 188 inpatients were analyzed. Results: The prevalence of dilutional hyponatremia, classified as serum sodium concentrations of ≤135 mmol/ℓ, ≤130 mmol/ℓ, and ≤125 mmol/ℓ, were 20.8%, 14.9%, and 12.2%, respectively. The serum sodium level was strongly associated with the severity of liver function impairment as assessed by Child-Pugh and MELD scores (p<0.0001). Even a mild hyponatremia with a serum sodium concentration of 131-135 mmol/ℓ was associated with severe complications. Sodium levels less than 130 mmol/ℓ indicated the existence of massive ascites (OR, 2.685; CI, 1.316-5.477; p=0.007), grade III or higher hepatic encephalopathy (OR, 5.891; CI, 1.490-23.300;p=0.011), spontaneous bacterial peritonitis (OR, 2.562; CI, 1.162-5.653; p=0.020), and hepatic hydrothorax (OR,5.723; CI, 1.889-17.336; p=0.002). Conclusions: Hyponatremia, especially serum levels ≤130 mmol/ℓ, may indicate the existence of severe complications associated with liver cirrhosis.
참고문헌 (23)
- Angeli P, "Hyponatremia in cirrhosis: results of a patient population survey", Hepatology, 44, pp.1535~1542 (2006)
- Heuman DM, "Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death", Hepatology, 40, pp.802~810 (2004)
- Fernandez-Esparrach G, "A prognostic model for predicting survival in cirrhosis with ascites", J Hepatol, 34, pp.46~52 (2001)
- Ripoll C, "Influence of hepatic venous pressure gradient on the prediction of survival of patients with cirrhosis in the MELD Era", Hepatology, 42, pp.793~801 (2005)
- Arroyo V, "Prognostic value of spontaneous hyponatremia in cirrhosis with ascites", Am J Dig Dis, 21, pp.249~256 (1976)
- Llach J, "Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites", Gastroenterology, 94, pp.482~487 (1988)
- Gines P, "Compensated cirrhosis: natural history and prognostic factors", Hepatology, 7, pp.122~128 (1987)
- Cosby RL, "New classification with prognostic value in cirrhotic patients", Miner Electrolyte Metab, 15, pp.261~266 (1989)
- Fernandez-Esparrach G, "A prognostic model for predicting survival in cirrhosis with ascites", J Hepatol, 34, pp.46~52 (2001)
- Gines P, "Hyponatremia in cirrhosis: from pathogenesis to treatment", Hepatology, 28, pp.851~864 (1998)
- Anthony PP, "The morphology of cirrhosis: recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization", J Clin Pathol, 31, pp.395~414
- Moore KP, "The management of ascites in cirrhosis: reports on the consensus conference of the International Ascites Club", Hepatology, 38, pp.258~266 (2003)
- Atterbury CE, "-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy: a controlled, double-blind clinical tria", Am J Dig Dis, 23, pp.398~406 (1978)
- The Korean Association for the Study of the Liver, "Treatment guidelines of the complications of the liver cirrhosis", Korean J Hepatol, 11(4), pp.111~163 (2005)
- Beppu K, "Prediction of variceal hemorrhage by esophageal endoscopy", Gastrointest Endosc, 27, pp.213~218 (1981)
- Adrogué HJ, "Hyponatremia", N Engl J Med, 342, pp.1581~1589 (2000)
- Borroni G, "Clinical relevance of hyponatraemia for the hospital outcome of cirrhotic patients", Dig Liver Dis, 32, pp.605~610 (2000)
- Restuccia T, "Effects of dilutional hyponatremia on brain organic osmolytes and water content in patients with cirrhosis", Hepatology, 39, pp.1613~1622 (2004)
- McGee JO, "The role of perisinusoidal cells in hepatic fibrogenesis: an electron microscopic study of acute carbon tetrachloride liver injury", Lab Invest, 26, pp.429~440 (1972)
- Malinchoc M, "A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts", Hepatology, 31, pp.864~871 (2000)
- Forman LM, "Predicting the prognosis of chronic liver disease: an evolution from child to MELD", Hepatology, 33, pp.473~475 (2001)
- Wong VW, "Performance of the new MELD-Na score in predicting 3-month and 1-year mortality in Chinese patients with chronic hepatitis B", Liver Transpl, 13, pp.1228~1235 (2007)
- Biggins SW, "Evidence-based incorporation of serum sodium concentration into MELD", Gastroenterology, (130), pp.1625~1660 (2006)