Mathur Sachin, Gane Edward J, McCall John L, Plank Lindsay D
Department of Surgery, University of Auckland, Auckland, New Zealand.
J Gastroenterol Hepatol. 2008 Feb;23(2):239-43. doi: 10.1111/j.1440-1746.2007.04891.x. Epub 2007 Apr 19.
Serum sodium may have prognostic value in addition to the model for end-stage liver disease (MELD) score for prediction of early mortality in patients listed for liver transplant. In patients with cirrhosis, over-hydration is a common feature but its prognostic value has not been evaluated. This study examines the independent prognostic significance of MELD, serum sodium and hydration status on long-term survival in patients with cirrhosis.
Serum sodium and hydration (total body water as a percentage of fat-free mass) were measured in 227 consecutive cirrhotic patients (146 male, 81 female; median age 49 years, range 19-73 years; median MELD score 13, range 6-36). Patients with hepatocellular carcinoma or listed for liver transplantation at the time of initial assessment were excluded. A competing risks Cox proportional hazards analysis was performed to evaluate the influence of MELD, sodium and hydration on risk of death or transplant.
Median follow-up was 52 (range 4-93) months. Serum sodium and hydration were each associated with reduction in time to death or transplant on univariate analysis (sodium: hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.87-0.94, P < 0.0001; hydration: HR 1.20, 95% CI 1.10-1.30, P < 0.0001). On multivariate analysis, MELD, serum sodium and hydration were independently predictive of death or transplant (MELD: HR 1.12, 95% CI 1.06-1.19, P < 0.0001; sodium: HR 0.93, 95% CI 0.87-0.99, P = 0.04; hydration: HR 1.17, 95% CI 1.02-1.33, P = 0.02).
In non-waitlisted patients with cirrhosis, serum sodium is predictive of transplant or death independent of MELD score.
血清钠除了终末期肝病模型（MELD）评分外，可能对预测肝移植患者早期死亡率具有预后价值。在肝硬化患者中，水合过度是一个常见特征，但其预后价值尚未得到评估。本研究探讨了MELD、血清钠和水合状态对肝硬化患者长期生存的独立预后意义。
对227例连续的肝硬化患者（146例男性，81例女性；中位年龄49岁，范围19 - 73岁；中位MELD评分13，范围6 - 36）测量血清钠和水合状态（总体水占去脂体重的百分比）。排除初次评估时患有肝细胞癌或已列入肝移植名单的患者。进行竞争风险Cox比例风险分析，以评估MELD、钠和水合状态对死亡或移植风险的影响。
中位随访时间为52（范围4 - 93）个月。单因素分析显示，血清钠和水合状态均与死亡或移植时间的缩短相关（钠：风险比[HR] 0.90，95%置信区间[CI] 0.87 - 0.94，P < 0.0001；水合状态：HR 1.20，95% CI 1.10 - 1.30，P < 0.0001）。多因素分析显示，MELD、血清钠和水合状态可独立预测死亡或移植（MELD：HR 1.12，95% CI 1.06 - 1.19，P < 0.0001；钠：HR 0.93，95% CI 0.87 - 0.99，P = 0.04；水合状态：HR 1.17，95% CI 1.02 - 1.33，P = 0.02）。
在未列入等待名单的肝硬化患者中，血清钠可独立于MELD评分预测移植或死亡。
