Abstract

RAFAEL VALDIVIA, Lourdes  and  FERRANDIZ QUIROZ, Jorge. Hyponatremia as a possible mortality factor in cirrhotic patients hospitalised in the Guillermo Almenara Irigoyen state hospital, 2003 - 2005. Rev. gastroenterol. Perú [online]. 2007, vol.27, n.1, pp.37-46. ISSN 1022-5129.

Introduction: In the decompensated hepatic cirrhosis the development of complications such as bleeding in the digestive tracts, encephalopathy, ascites and spontaneous bacterial peritonitis is well-known; another important complication is the development of dilutional hyponatremia resulting from severe circulatory and renal dysfunction and which different papers have linked to a higher mortality rate. The main purpose of the present study is to determine if hyponatremia is an independent prognosis factor in the mortality of cirrhotic patients. Material and Methods: A retrospective study of cases and controls was carried out. Cirrhotic patients hospitalized in the Guillermo Almenara Irigoyen Hospital from January 2003 to June 2005 were evaluated; the patients who died with MELD10 were defined as cirrhotic; the controls were living cirrhotic patients with MELD≤10. They further were classified according to the presence or not of hyponatremia. For each group the clinical and analytical characteristics, the extent of the hepatic dysfunction and the seric levels of sodium were established. In order to compare the groups the student t test was used; to determine if hyponatremia was an independent prognosis factor of mortality the raw OR and the adjusted OR were calculated, the latter through a model of logistic regression. Results: Forty (40) test patients and 56 controls were used. Hyponatremia was found in 28.13% of the total of cirrhotic patients and in 50% of the deceased cirrhotic patients. Upon comparing the groups of alive and deceased cirrhotic patients a significant difference was found in terms of the age (p=0.0013), Child (p=0.000), MELD (p=0.004), bilirrubin (p=0.009), albumin (p=0.000), creatinine (p=0.019) and seric sodium (p=0.002). The independent mortality risk factors were the presence of hyponatremi (adjusted OR); 4.83, IC-95% 1.42 - 16.49), the previous SAE (adjusted OR: 3.42, IC - 95% 1.13- 10.33) and the presence of associated infection (adjusted OR: 4.83, IC - 95% 1.55- 15.03). Conclusions: The prevalence of hyponatremia in hospitalized cirrhotic patients with MELD≥10 was 28.13%. Hyponatremia, previous ascites and linked infection are independent prognosis factors for mortality of cirrhotic patients. 

Keywords : Hyponatremia; mortality; cirrhosis.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )