Hyponatremia a valuable predictor of early mortality in patients with cirrhosis listed for liver transplantation

Abstract

The current policy for organ allocation in liver transplantation is to give priority to the sickest patients mostly using model for end-stage liver disease (MELD) score in ranking. However, other factors as serum sodium may be of value in predicting early mortality. In this single-center study, patients with cirrhosis over age 14 on the liver transplant wait-list from September 1998 to June 2007 were followed for six months from the time of listing to evaluate the value of hyponatremia on mortality. Of 612 listed patients, 51 were transplanted who were excluded from survival analysis and 55 died without transplantation within the first three months. The numbers of transplanted and dead patients during months 3-6 were 29 and 24, respectively. Both MELD score and serum sodium at the time of listing were independent predictors of early mortality. On bivariate analysis, serum sodium of <130 mEq/L beside MELD was a significant predictor of mortality within 90 and 180 d. Serum sodium level <135 mEq/L masked the difference in mortality between patients with refractory and non-refractory ascites. Serum sodium level of <130 mEq/L and an increased MELD score are significant predictors of early mortality in patients listed for liver transplantation.

Model for End-stage Liver Disease

“…Similar observations about the impact of serum sodium between 125 and 140 mmol/L on the waitlist mortality have been made by other workers. 125 Amongst patients with severe hyponatremia (<125 mmol/L), serum sodium was a better predictor of mortality than MELD score amongst patients with refractory ascites. 126 Data on the impact of sodium on the accuracy of MELD score are controversial as reported by other studies.…”

Central Pontine Myelinolysis After Living-Donor Liver Transplant: A Report of 2 Cases

“…[5][6][7] Many studies have shown that hyponatremia is a risk factor for CPM and that rapid sodium replacement is one of the principal stimuli. 1,2,8 Possible mechanisms of CPM include (1) glial dehydration and shrinkage due to a hyperosmotic state, resulting in separation of the axon from its myelin sheath with myelin injury and necrosis, and (2) fast recovery and maintenance of an intracellular osmolar state causing high-energy demand in the face of inadequate energy supply, resulting in oligodendroglial cell apoptosis.…”

Hyponatremia: Clinical Associations, Prognosis, and Treatment in Cirrhosis

“…1 This association between liver disease severity and hyponatremia has been confirmed by other studies (Table 1). 1,4,[9][10][11][12][13][14][15][16][17][18][19][20][21] When assessing the region or country of origin, the frequency of hyponatremia was lower in patients from Asia and South America than it was in Western and Central Europe and North America. 1 This finding raises the question of the role of diet and lifestyle on outcomes in hyponatremia in cirrhosis.…”

“…Numerous studies have shown serum sodium as an pretransplant and posttransplant predictor of morbidity and short-term mortality, independent of the MELD score, where both the MELD and serum sodium concentration were predictive of death at 90 days among patients on the liver transplant waiting list. 1,9,11,[43][44][45][46][47][48][49][50][51][52] The MELD score has been criticized for its limited prognostic accuracy for certain subgroups including patients with cirrhosis, complicated by ascites and hyponatremia. 9,43,49,53 Invariably, the predictability of MELD score is enhanced with the incorporation of sodium (Table 2).…”

“…Pretransplant, it is associated with several clinical manifestations of decompensation, 4,7,8 and the degree of hyponatremia may increase the accuracy of the model for end-stage liver disease (MELD) score to predict survival. [8][9][10][11] Treatment of hyponatremia has not been demonstrated to improve survival in patients with advanced liver disease, and rapid correction can lead to life-threatening neurologic complications. 12,13 This systematic review focuses on the prevalence, clinical associations, treatment, and prognosis of hypervolemic hyponatremia in patients with liver disease.…”