Division of Critical Care Nephrology, Department of Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
J Clin Gastroenterol. 2010 Mar;44(3):220-6. doi: 10.1097/MCG.0b013e3181aabbcd.
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.
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.
Overall hospital mortality was 65.1%. Comparing with serum sodium >135 mmol/L, patients with serum sodium <or=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 <or=135 mmol/L.
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.
终末期肝病常伴有低钠血症。入住重症监护病房（ICU）的伴有低钠血症的肝硬化患者死亡率较高。本研究分析了危重症肝硬化患者的结局，并确定了血清钠浓度的预后价值。
本研究纳入了 1.5 年内入住一家三级中心 ICU 的 126 例连续肝硬化患者。前瞻性记录 ICU 入院第 1 天的人口统计学、临床和实验室变量，进行事后分析。
总体住院死亡率为 65.1%。与血清钠>135mmol/L 的患者相比，血清钠≤135mmol/L 的患者腹水、疾病严重程度评分、肝性脑病、脓毒症、肾衰竭和住院死亡率更高（55.9%比 73.1%，P=0.043）。多因素 Cox 比例风险分析显示，血清钠水平、入院第 1 天的肝细胞癌和序贯器官衰竭评估评分是 6 个月死亡率的独立危险因素。出院后 6 个月随访的累积生存率在血清钠>135mmol/L 的患者与血清钠≤135mmol/L 的患者之间有显著差异（P<0.05）。
危重症肝硬化患者低血清钠水平与肝硬化并发症、住院死亡率和短期预后不良相关。血清钠浓度是肝移植候选者生存的重要预测因子。连续应用血清钠的未来研究可能反映临床状况的动态方面，从而为死亡率风险提供完整的数据。
