Hyponatraemia in Cirrhosis- Prevalence and Correlation With the Complications of Cirrhosis

Abstract

BACKGROUNDHyponatraemia is one of the complications in cirrhotic patients, occurring in more than one-third of the patients with chronic liver disease and is believed to be caused by defective water homeostasis. The objective of our study is to establish the prevalence of hyponatraemia in cirrhosis and to investigate if hyponatraemia predicts a rate of severity of complications in cirrhosis. MATERIALS AND METHODSA cross-sectional study was done in patients diagnosed with cirrhosis by a combination of clinical, biochemical and radiological findings. Demographic data and biochemical parameters including serum sodium levels were recorded at the time of admission or at the time of presentation in the outpatient department and patients were stratified into three groups: Group A-serum sodium < 130 mmoL; Group B-serum sodium between 131 -135 mmol/L; Group C-serum sodium > 136 mmol/L. A detailed case report proforma was used for data collection for each patient. RESULTSHundred patients were included in the study. 44 patients had serum sodium level of < 130 mmol/L (Group A), 26 patients had serum sodium 131 -135 mmol/L (Group B) and 30 patients noted to have serum sodium > 136 mmol/L (Group C). Majority of Group A patients belonged to 31 -40 years of age (34%) and male gender (77%). Group A patients had rising serum bilirubin levels of 10.01 to 20 mg/dL (34%) compared to Group B and C (3.85% and 3.3% respectively). 84% of Group A patients had serum albumin < 3.5 g/dL. Blood urea levels > 40 mg/dL and serum creatinine > 1.3 mg/dL are associated with > 50% of Group A patients. 37 patients had worsening hepatic encephalopathy in Group A. 38% of Group A are associated with spontaneous bacterial peritonitis. 95% of Group A patients had portal hypertension compared to 65% of Group B and 11% of Group C. The incidence of class 3 Child-Turcotte Pugh score was significantly higher in Group A (70.28%). High MELD score (20 -29) is associated with Group A patients (43.18%). CONCLUSIONThis study was undertaken to establish serum sodium as an independent variable in the prognosis of patients with decompensated liver disease, irrespective of the aetiology. MELD Na scores calculated using serum sodium values have been recently found to supersede MELD scores to determine prognosis. By comparing MELD vs. MELD Na scores, this study concludes that MELD Na scores have been found to be more significant as a prognostic marker in patients with cirrhosis and its complications.

Dysnatremia in patients with chronic liver disease: a cross-sectional observational study

“…In similar research, Meganathan et colleagues found that ALT, AST, and ALP were not substantially related to serum sodium levels. 12 Elkady et al also found no correlation between ALP, AST, AST, and bilirubin and hyponatremia. Umemura et colleagues discovered that individuals with serum sodium levels of 139 mEq/l had considerably reduced median AST, ALT, GGT, and total bilirubin.…”

An observational cross-sectional study of the serum sodium levels and their association with severity in chronic liver disease patients in a tertiary care center in Haryana

“…Meganathan and Kumar established the prevalence of hyponatremia in cirrhosis and to investigate if hyponatremia predicts an increased rate and severity of complications in cirrhosis. 9 They reported hyponatremia in 44%, normal serum sodium in 26%, and hypernatremia in 30% of the patients. In another study, Umemura et al, evaluated mortality in cirrhosis patients taking conventional diuretics and identified associations between serum sodium level and clinical characteristics.…”

“…Group A Group B Group C (P<0.01) were found to occur significantly more commonly among patients from Group A, as compared to those in patients from Group B or C. In a similar study by Meganathan and Kumar, the majority of the hyponatremic patients had the hepatorenal syndrome. 9 The incidence of portal hypertension was 95% in patients with severe hyponatremia. About 84% of the hyponatremic patients had the hepatorenal syndrome.…”

“…In another study by Meganathan and Kumar, the mean MELD score was 27.7±6.7 for patients with hyponatremia, which was significantly higher as compared to those with normal serum sodium levels and hypernatremia. 9…”