Serum Sodium Identifies Patients with Cirrhosis at High Risk of Hepatorenal Syndrome

Abstract

Background: Although the precipitating events of hepatorenal syndrome (HRS) development have been well characterized, the actual baseline risk of these events resulting in HRS is much less studied.

Aim: To assess the predictive value of hyponatremia in the development of HRS.

Patients and methods: We performed a retrospective observational cohort study including consecutive patients with decompensated liver cirrhosis and normal creatininemia admitted to tertiary center in Slovakia. Patients were censored at two months, development of renal failure, classified either as HRS or renal failure not fulfilling criteria of HRS, was the main outcome.

Results: Out of 202 patients 18 developed HRS and 14 renal failure not fulfilling the HRS criteria. A significant difference was found between patients with and without HRS in serum sodium (135.76 ± 5.01 vs. 130.78 ± 3.574 mmol/l; p < 0.0001), creatinine, (81 ± 20.11 vs. 98.18 ± 25.032 µmol/l; p = 0.006), bilirubin (90.4 ± 104.82 vs.175.42 ± 174.12 µmol/l; p < 0.0001), MELD (15.17 ± 5.52 vs. 21.61 ± 6.0; p < 0.0001) and MELD-Na score (19.96 ± 6.0 vs. 25.89 ± 4.96; p < 0.0001). Sodium, creatinine, bilirubin, MELD, MELD-Na score were found to be significant predictors of HRS in univariate analysis. Multivariate analysis two prediction models (Model 1: Bilirubin, creatinin, sodium and Model 2: Sodium, MELD) showed that sodium together with creatinine are the strongest HRS predictors, followed by bilirubin or MELD score.

Conclusion: Serum levels of sodium, creatinine and parameters of liver function are important predictors of hepatorenal syndrome.

Zusammenfassung

Hintergrund: Obwohl die verschiedenen begleitenden Faktoren in der Entwicklung eines hepatorenalen Syndroms (HRS) sehr gut charakterisiert sind, wird das tatsächliche Risiko von HRS-Entstehung weniger untersucht.

Ziel: Die Beurteilung des prädikativen Wertes der Hyponatriämie in der Entwicklung eines HRS.

Patienten und Methodik: Wir führten eine retrospektive Beobachtungsstudie in Form einer Kohortenstudie durch, die konsekutiven Patienten mit dekompensierter Leberzirrhose und normalen Serum-Kreatinin-Werten einschloss. Die Patienten wurden in ein tertiäres Zentrum in der Slowakei aufgenommen. Nach 2 Monaten folgte die Sortierung der Patienten. Das Hauptkriterium stellte die Entstehung des Nierenversagens dar, klassifiziert entweder als HRS oder Nierenversagen ohne erfüllte HRS-Kriterien.

Ergebnisse: Von insgesamt 202 Patienten entwickelte sich bei 18 ein HRS und bei 14 ein Nierenversagen ohne erfüllte HRS-Kriterien. Einen signifikanten Unterschied fanden wir im Serum-Natrium (135,76 ± 5,01 vs. 130,78 ± 3,574 mmol/l; p < 0,0001), Kreatinin (81 ± 20,11 vs. 98,18 ± 25,032 µmol/l; p = 0,006), Bilirubin (90,4 ± 104,82 vs.175,42 ± 174,12 µmol/l; p < 0,0001), MELD (15,17 ± 5,52 vs. 21,61 ± 6,0; p < 0,0001) und MELD-Na Score (19,96 ± 6,0 vs. 25,89 ± 4,96; p < 0,0001) zwischen Patienten mit und ohne HRS. Natrium, Kreatinin, Bilirubin, MELD, MELD-Na Score wurden in der univariaten Analyse als signifikante Prädiktoren vom HRS nachgewiesen. Die multivariate Analyse von 2 Prädiktor-Modellen (Modell 1: Bilirubin, Kreatinin, Sodium und Modell 2: Sodium, MELD) zeigte, dass die stärkste HRS-Prädiktoren Natrium zusammen mit Kreatinin darstellten, gefolgt von Bilirubin sowohl auch MELD-Score.

Schlussfolgerung: Serumwerte von Natrium, Kreatinin und Leberfunktionsparametern sind wichtige Prädiktoren eines hepatorenalen Syndroms.

Schlüsselwörter

Leberzirrhose - hepatorenales Syndrom - Natrium - Prädiktor

Key words

liver cirrhosis - hepatorenal syndrome - sodium - predictor

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