Clinical profile of hyponatremia in patients with decompensated chronic liver disease: A cross-sectional study.

Venugopal Margekar; Anusha Chouhan; Vanini

doi:10.51168/dqbvvw96

Autori

Venugopal Margekar Assistant Professor, Department of Medicine, Pt. JNM Medical College, Raipur, Chhattisgarh, India.
Anusha Chouhan Senior Resident, Department of Medicine, Pt. JNM Medical College, Raipur, Chhattisgarh, India.
Vanini Senior Resident, Department of Hospital Administration, Rajendra Institute of Medical Science, Ranchi, Jharkhand, India.

DOI:

https://doi.org/10.51168/dqbvvw96

Cuvinte cheie:

Hyponatremia,, Decompensated Chronic Liver Disease, Ascites, Hepatic Encephalopathy, Serum Sodium, Cirrhosis

Rezumat

Background

Hyponatremia is a common electrolyte abnormality in patients with decompensated chronic liver disease and is associated with severe complications and poor prognosis. This study evaluated the clinical profile and severity of hyponatremia among hospitalized patients with decompensated chronic liver disease.

Methodology

A hospital-based cross-sectional study was conducted in the Department of Medicine, Pt. J.N.M. Medical College and Dr. B.R.A.M. Hospital, Raipur, over a period of one year. A total of 198 admitted patients with decompensated chronic liver disease were included. Clinical history, physical examination findings, laboratory investigations, and serum sodium levels were recorded. Statistical analysis was performed using SPSS version 26. Continuous variables were expressed as mean ± standard deviation, whereas categorical variables were represented as frequencies and percentages. Chi-square test and independent t-test were used for analysis. A p-value <0.05 was considered statistically significant.

Results

Among 198 patients, males constituted 74.2% and females 25.8%. The mean age was 51.8±12.6 years. Hyponatremia (<135 mEq/L) was observed in 139 patients (70.2%). Severe hyponatremia (<125 mEq/L) was present in 17.2% of cases. Ascites (86.4%), jaundice (79.3%), pedal edema (65.7%), hepatic encephalopathy (36.4%), and gastrointestinal bleeding (24.7%) were the common manifestations. Severe hyponatremia was significantly associated with a higher frequency of hepatic encephalopathy (p=0.003), spontaneous bacterial peritonitis (p=0.021), and prolonged hospitalization (p=0.001).

Conclusion

Hyponatremia is highly prevalent among patients with decompensated chronic liver disease and correlates with disease severity and complications. Early identification and correction of sodium imbalance may improve clinical outcomes.

Recommendation

Routine assessment and monitoring of serum sodium should be incorporated into the standard management protocol of decompensated chronic liver disease patients.

Biografii autori

Venugopal Margekar, Assistant Professor, Department of Medicine, Pt. JNM Medical College, Raipur, Chhattisgarh, India.

Pt. J.N.M. Medical College, Raipur, Chhattisgarh, India. His clinical and research interests include hepatology, internal medicine, chronic liver disease, and electrolyte disorders.
Anusha Chouhan, Senior Resident, Department of Medicine, Pt. JNM Medical College, Raipur, Chhattisgarh, India.

is a Senior Resident in the Department of Medicine at Pt. J.N.M. Medical College, Raipur. Her areas of interest include gastroenterology, hepatology, and evidence-based clinical research.
Vanini, Senior Resident, Department of Hospital Administration, Rajendra Institute of Medical Science, Ranchi, Jharkhand, India.

is a Senior Resident in the Department of Hospital Administration at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. Her research interests include hospital administration, healthcare quality improvement, health services research, and clinical outcomes evaluation.

Referințe

1. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151-71. https://doi.org/10.1016/j.jhep.2018.09.014

2. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838-51. https://doi.org/10.1016/S0140-6736(08)60383-9

3. D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: A systematic review of 118 studies. J Hepatol. 2006;44(1):217-31. https://doi.org/10.1016/j.jhep.2005.10.013

4. Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology. 1996;23(1):164-76. https://doi.org/10.1002/hep.510230122 https://doi.org/10.1053/jhep.1996.v23.ajhep0230164

5. Ginès P, Berl T, Bernardi M, Bichet DG, Hamon G, Jiménez W, et al. Hyponatremia in cirrhosis: From pathogenesis to treatment. Hepatology. 1998;28(3):851-64. https://doi.org/10.1002/hep.510280337

6. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodés J. Peripheral arterial vasodilation hypothesis: A proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology. 1988;8(5):1151-57. https://doi.org/10.1002/hep.1840080532

7. Bernardi M, Angeli P, Claria J, Moreau R, Ginès P, Jalan R, et al. Albumin in decompensated cirrhosis: New concepts and perspectives. Gut. 2020;69(6):1127-38. https://doi.org/10.1136/gutjnl-2019-318843

8. Biggins SW, Kim WR, Terrault NA, Saab S, Balan V, Schiano T, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology. 2006;130(6):1652-60. https://doi.org/10.1053/j.gastro.2006.02.010

9. Cárdenas A, Ginès P. Management of patients with cirrhosis awaiting liver transplantation. Gut. 2011;60(3):412-21. https://doi.org/10.1136/gut.2009.179937

10. Angeli P, Wong F, Watson H, Ginès P. Hyponatremia in cirrhosis: Results of a patient population survey. Hepatology. 2006;44(6):1535-42. https://doi.org/10.1002/hep.21412

11. Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018-26. https://doi.org/10.1056/NEJMoa0801209

12. European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-60. https://doi.org/10.1016/j.jhep.2018.08.009

13. Borroni G, Maggi A, Sangiovanni A, Cazzaniga M, Salerno F. Clinical relevance of hyponatremia for the hospital outcome of cirrhotic patients. Dig Liver Dis. 2000;32(7):605-10. https://doi.org/10.1016/S1590-8658(00)80844-0

14. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome developing in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426-37. https://doi.org/10.1053/j.gastro.2013.02.042

15. Arroyo V, Moreau R, Jalan R, Ginès P. Acute-on-chronic liver failure: A new syndrome that will reclassify cirrhosis. J Hepatol. 2015;62(1 Suppl): S131-43. https://doi.org/10.1016/j.jhep.2014.11.045

16. Ginès P, Quintero E, Arroyo V, Terés J, Bruguera M, Rimola A, et al. Compensated cirrhosis: Natural history and prognostic factors. Hepatology. 1987;7(1):122-28. https://doi.org/10.1002/hep.1840070124

17. Bernardi M, Ricci CS, Zaccherini G. Role of human albumin in the management of complications of liver cirrhosis. J Clin Exp Hepatol. 2014;4(4):302-11. https://doi.org/10.1016/j.jceh.2014.08.007

18. Schrier RW, Martin PY, Lee SS. Pathogenesis and management of sodium and water retention in cirrhosis. Semin Liver Dis. 1994;14(3):202-13.

19. Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases practice guideline management of adult patients with ascites due to cirrhosis. Hepatology. 2013;57(4):1651-53. https://doi.org/10.1002/hep.26359

20. D'Amico G, Morabito A, D'Amico M, Pasta L, Malizia G, Rebora P, et al. Clinical states of cirrhosis and competing risks. J Hepatol. 2018;68(3):563-76. https://doi.org/10.1016/j.jhep.2017.10.020

21. Nusrat S, Khan MS, Fazili J, Madhoun MF. Cirrhosis and its complications: Evidence-based treatment. World J Gastroenterol. 2014;20(18):5442-60. https://doi.org/10.3748/wjg.v20.i18.5442

22. Córdoba J, Guevara M. Hyponatremia and hepatic encephalopathy in cirrhosis. Gastroenterol Hepatol. 2003;26(1):29-37.

23. Guevara M, Baccaro ME, Torre A, Gómez-Ansón B, Ríos J, Torres F, et al. Hyponatremia is a risk factor of hepatic encephalopathy in patients with cirrhosis. Hepatology. 2009;50(4):1133-40.

24. Heuman DM, Abou-Assi SG, Habib A, Williams LM, Stravitz RT, Sanyal AJ, et al. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death. Hepatology. 2004;40(4):802-10. https://doi.org/10.1002/hep.1840400409

25. Ginès P, Cárdenas A. The management of ascites and hyponatremia in cirrhosis. Semin Liver Dis. 2008;28(1):43-58. https://doi.org/10.1055/s-2008-1040320