Relationship of hyponatremia with degree of liver injury and prognosis in patients with decompensated liver cirrhosis

Objective To investigate the relationship between hyponatremia and degree of liver injury,complications and survival time,and the prognostic value of hyponatremia in patients with decompensated liver cirrhosis. Methods A total of 218 patients who were diagnosed with decompensated liver cirrhosis for the first time in The First Affiliated Hospital of Dalian Medical University from January 2000 to March2005 were enrolled in this study,and according to the serum sodium concentration,these patients were divided into group Ⅰ with a serum sodium concentration of ≥130 mmol / L( n = 51),group Ⅱ with a serum sodium concentration of ≥120 and < 130 mmol / L( n = 97),group Ⅲ with a serum sodium concentration of < 120 mmol / L( n = 70). The patients' sex,age,serum sodium concentration,Child- Pugh class,and complications were analyzed,and the survival time was calculated. The one- way analysis of variance was applied for comparison of continuous data between groups,and the least significant difference t- test was applied for comparison between any two patients; the chi- square test was applied for comparison of categorical data between groups; the Kaplan- Meier method was applied for survival analysis,and the Cox regression model was applied for regression analysis. Results Compared with groups Ⅰ and Ⅱ,group Ⅲ had the highest proportion of patients with Child- Pugh C cirrhosis. With the increasing Child- Pugh score,the serum sodium concentration decreased; the serum sodium concentration showed significant differences across the patients with Child- Pugh A,B,and C cirrhosis( F = 17. 336,P <0. 001),and differed significantly between any two groups of these patients( all P < 0. 05). Compared with groups Ⅰ and Ⅱ,group Ⅲ had the highest incidence rate of complications,and the incidence rates of hepatic encephalopathy and hepatorenal syndrome showed significant differences across the three groups( χ2= 17. 718 and 6. 277,both P < 0. 05). Group Ⅲ had a significantly shorter survival time than groupsⅠ and Ⅱ( both P < 0. 05). Conclusion In patients with decompensated liver cirrhosis,the severity and incidence rate of hyponatremia increase significantly as liver injury becomes more severe,which suggests that hyponatremia can be used as a prognostic indicator in patients with decompensated liver cirrhosis.