Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Sci Rep. 2018 Dec 21;8(1):18023. doi: 10.1038/s41598-018-37006-7.
Preoperative hyponatremia is associated with an increased risk of mortality on the liver transplantation (LT) waiting list. We sought to investigate the impact of pre- and intraoperative serum sodium levels on the one-year mortality after LT. We identified 1,164 patients for whom preoperative and intraoperative serum sodium levels were available. Cox regression analysis with multivariable adjustment was performed for one-year mortality. A propensity score matching analysis was performed for preoperative and intraoperative serum sodium groups to compare one-year survival. The cutoff of sodium level with minimal p-value was 130 mEq/L for both preoperative and intraoperative sodium. Intraoperative hyponatremia was an independent predictor of one-year mortality in the multivariable Cox regression analysis, while preoperative hyponatremia was not. Kaplan-Meier curve showed that there was a significant difference in the one-year mortality between preoperative and intraoperative serum sodium groups. However, after propensity score matching, there was no difference in the one-year mortality among the preoperative sodium groups, while there was a significant difference among the intraoperative sodium groups. Intraoperative hyponatremia defined by mean sodium <130 mEq/L was independently associated with a significantly high one-year mortality. Mean intraoperative serum sodium levels may be a better prognostic predictor than preoperative serum sodium levels.
术前低钠血症与肝移植（LT）等待名单上的死亡率增加相关。我们试图研究 LT 后一年内术前和术中血清钠水平对死亡率的影响。我们确定了 1164 名患者，他们的术前和术中血清钠水平可用。进行了多变量调整的 Cox 回归分析，以研究一年的死亡率。对术前和术中血清钠组进行倾向评分匹配分析，以比较一年的生存率。术前和术中钠的最小 p 值的截断值均为 130 mEq/L。术中低钠血症是多变量 Cox 回归分析中一年死亡率的独立预测因素，而术前低钠血症则不是。Kaplan-Meier 曲线显示，术前和术中血清钠组之间一年死亡率有显著差异。然而，在进行倾向评分匹配后，术前血清钠组之间一年死亡率无差异，而术中血清钠组之间有显著差异。术中以平均钠 <130 mEq/L 定义的低钠血症与一年高死亡率显著相关。术中血清钠水平均值可能是比术前血清钠水平更好的预后预测指标。
