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Serum Sodium Predicts Prognosis in Critically Ill Cirrhotic Patients

Jenq, Chang-Chyi MD*; Tsai, Ming-Hung MD; Tian, Ya-Chung PhD*; Chang, Ming-Yang PhD*; Lin, Chan-Yu MD*; Lien, Jau-Min PhD; Chen, Yung-Chang MD*; Fang, Ji-Tseng MD*; Chen, Pan-Chi MD; Yang, Chih-Wei MD*

Journal of Clinical Gastroenterology: March 2010 - Volume 44 - Issue 3 - pp 220-226
doi: 10.1097/MCG.0b013e3181aabbcd
LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Background: End-stage liver disease is often complicated by hyponatremia. Cirrhotic patients with hyponatremia admitted to intensive care units (ICUs) have high mortality rates. This study analyzed the outcomes of critically ill cirrhotic patients and identified the prognostic value of serum sodium concentration.

Methods: One hundred twenty-six consecutive cirrhotic patients admitted to the ICU of a tertiary center during a 1.5-year period were enrolled in this study. Demographic, clinical, and laboratory variables on the first day of ICU admission were prospectively recorded for post hoc analysis.

Results: Overall hospital mortality was 65.1%. Comparing with serum sodium >135 mmol/L, patients with serum sodium ≤135 mmol/L had a greater frequency of ascites, illness severity scores, hepatic encephalopathy, sepsis, renal failure, and in-hospital mortality (55.9% vs. 73.1%, P=0.043). Multiple Cox proportional hazards analysis revealed that serum sodium levels, hepatocellular carcinoma, and sequential organ failure assessment scores on the first day of ICU admission were independent risk factors for 6-month mortality. Cumulative survival rates at 6-month follow-up after hospital discharge differed significantly (P<0.05) between patients with serum sodium >135 mmol/L versus those with serum sodium ≤135 mmol/L.

Conclusions: Low serum sodium levels in critically ill cirrhotic patients are associated with high complications of liver cirrhosis, in-hospital mortality, and poor short-term prognosis. The serum sodium concentration is important predictor of survival among candidates for liver transplantation. Future research with sequential application of serum sodium may reflect the dynamic aspects of clinical conditions, thus providing complete data for mortality risk.

*Division of Critical Care Nephrology, Department of Nephrology, Kidney Institute

Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan

Funding Declaration: This work was supported by the Chang Gung Medical Research Fund CMRPG-32064, Chang Gung Memorial Hospital, Linkou, Taiwan and in part by National Science Council of Taiwan (NSC 95-2314-B-182A-190).

Reprints: Yung-Chang Chen, MD, Division of Critical Care Nephrology, Department of Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Tung Hwa North Road, Taipei 105, Taiwan (e-mail: cyc2356@gmail.com).

Received for publication October 7, 2008

accepted April 17, 2009

Conflict of Interest Statement: None declared.

© 2010 Lippincott Williams & Wilkins, Inc.