Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Transplantation. 2022 Aug 1;106(8):1609-1614. doi: 10.1097/TP.0000000000004102. Epub 2022 Mar 14.
Hyponatremia before liver transplant (LT) increases risk of post-LT neurological complications in patients with decompensated cirrhosis, but it is unknown to what extent change in sodium from pre- to post-LT influences risk of central nervous system (CNS) sequelae. We assessed the relationship between pre- to post-LT delta sodium and prevalence of CNS complications during LT hospitalization.
We performed retrospective single-center chart review of 1265 adults with cirrhosis who underwent LT (2011-2020). Delta sodium is defined as the difference between maximum sodium within 48 h post-LT and lowest sodium within 7 d pre-LT. Primary outcomes are post-LT CNS events during same hospitalization-encephalopathy, delirium, seizure, coma, osmotic demyelination syndrome, or other altered mental status, determined by International Classification of Diseases codes. Secondary outcome is length of hospital stay post-LT (LOS). Logistic regression modeled association between delta sodium and post-LT CNS outcomes; negative binomial regression modeled LOS.
Median age was 59 y, 36% were female, and median Model for End-Stage Liver Disease score was 20. Median delta sodium was 8 mmol/L (interquartile range, 5-11). One hundred ninety-four (15%) experienced post-LT CNS complications. In multivariable analysis, controlling for confounders including pre-LT hyponatremia, every 5 mmol/L increase in delta sodium associated with 47% greater odds of CNS complication (95% confidence interval, 22%-77%). Delta sodium also associated with 7% increased LOS in adjusted regression (95% confidence interval, 3%-12%).
Adult LT recipients with higher perioperative delta sodium shifts displayed a higher risk of post-LT CNS complications, even after adjusting for pre-LT sodium. LT recipients, even those with pre-LT hyponatremia, may benefit from maintenance of stable serum sodium levels to minimize post-LT CNS complications.
在肝硬化失代偿患者中，肝移植（LT）前低钠血症会增加 LT 后神经并发症的风险，但 LT 前后钠的变化在多大程度上影响中枢神经系统（CNS）后遗症的风险尚不清楚。我们评估了 LT 住院期间 LT 前后钠差值与 CNS 并发症发生率之间的关系。
我们对 2011 年至 2020 年期间进行 LT 的 1265 例肝硬化成人进行了回顾性单中心图表回顾。Δ钠定义为 LT 后 48 小时内最大钠与 LT 前 7 天内最低钠之间的差异。主要结局是 LT 期间同一住院期间的 CNS 事件，通过国际疾病分类代码确定，包括脑病、谵妄、癫痫发作、昏迷、渗透性脱髓鞘综合征或其他精神状态改变。次要结局是 LT 后住院时间（LOS）。逻辑回归模型用于分析 Δ钠与 LT 后 CNS 结局之间的关系；负二项式回归模型用于分析 LOS。
中位年龄为 59 岁，36%为女性，中位终末期肝病模型评分 20 分。中位Δ钠为 8 mmol/L（四分位间距，5-11）。194 例（15%）发生 LT 后 CNS 并发症。在多变量分析中，在控制包括 LT 前低钠血症在内的混杂因素后，Δ钠每增加 5 mmol/L，CNS 并发症的几率增加 47%（95%置信区间，22%-77%）。Δ钠在调整后的回归中与 LOS 增加 7%相关（95%置信区间，3%-12%）。
围手术期Δ钠变化较大的 LT 受者术后 CNS 并发症风险增加，即使在调整 LT 前钠后也是如此。LT 受者，即使是 LT 前低钠血症患者，通过维持稳定的血清钠水平可能有助于减少 LT 后 CNS 并发症。
