Thuluvath Paul J, Alukal Joseph J, Zhang Talan
Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore MD, USA.
Department of Medicine, University of Maryland School of Medicine, Baltimore MD, USA.
J Clin Exp Hepatol. 2022 May-Jun;12(3):871-875. doi: 10.1016/j.jceh.2021.10.145. Epub 2021 Oct 28.
Ascites and hyponatremia are important milestones of worsening portal hypertension in those with cirrhosis. The objective of our study was to evaluate the differences in clinical characteristics, resource utilization, and disposition of hospitalized cirrhotic patients with ascites with and without hyponatremia.
The National Inpatient Sample (NIS) database was used to identify all adult hospitalized patients with a diagnosis of cirrhosis and ascites with or without hyponatremia from 2016 to 2017 using ICD-10 codes.
During the study period, 10,187 (7.6%) hospitalized patients with cirrhosis had ascites and hyponatremia and 34,555 (24.3%) had ascites but no hyponatremia. Elixhauser comorbidity score, excluding liver disease, was higher in hyponatremic patients (median 21 vs. 12, < 0.001). Acute kidney injury (50.3% vs. 32.8%, < 0.001) and sepsis (16.8% vs. 11.8%, < 0.001) were more common in hyponatremic patients compared to those without hyponatremia. Similarly, acute respiratory failure, coagulopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, acute (on chronic) liver failure, and liver cancer were more common in hyponatremic patients. Hyponatremia patients had a higher number of inpatient procedures, longer (6 days vs. 4 days, < 0.001) hospital stay, and had higher hospital charges ($97,327 vs. $72,278, < 0.01) than those without hyponatremia. Inpatient mortality was 38% higher in hyponatremic patients (9.8% vs. 7.1%, < 0.001) compared to those without hyponatremia. Additionally, hyponatremic patients were less likely to have routine home discharges with self-care.
In conclusion, using a large and diverse national cohort of unselected patients, we were able to show that hyponatremia in patients with cirrhosis and ascites is associated with poor clinical outcomes and increased resource utilization.
腹水和低钠血症是肝硬化患者门静脉高压恶化的重要标志。我们研究的目的是评估伴有和不伴有低钠血症的肝硬化腹水住院患者在临床特征、资源利用和处置方面的差异。
使用国家住院患者样本（NIS）数据库，通过国际疾病分类第十版（ICD - 10）编码，识别2016年至2017年所有诊断为肝硬化且伴有或不伴有低钠血症的成年住院患者。
在研究期间，10187名（7.6%）肝硬化住院患者伴有腹水和低钠血症，34555名（24.3%）患者有腹水但无低钠血症。低钠血症患者的埃利克斯豪泽合并症评分（不包括肝脏疾病）更高（中位数21对12，<0.001）。与无低钠血症的患者相比，急性肾损伤（50.3%对32.8%，<0.001）和脓毒症（16.8%对11.8%，<0.001）在低钠血症患者中更常见。同样，急性呼吸衰竭、凝血障碍、肝肾综合征、自发性细菌性腹膜炎、急性（慢性）肝衰竭和肝癌在低钠血症患者中也更常见。低钠血症患者的住院手术数量更多，住院时间更长（6天对4天，<0.001），住院费用更高（97327美元对72278美元，<0.01）。与无低钠血症的患者相比，低钠血症患者的住院死亡率高38%（9.8%对7.1%，<0.001）。此外，低钠血症患者进行常规家庭自我护理出院的可能性较小。
总之，通过使用一个来自全国的、庞大且多样的未选患者队列，我们能够证明肝硬化腹水患者的低钠血症与不良临床结局和资源利用增加有关。
