Abstract
Background and study aim: In cirrhotic patients, portal hemodynamics is associated with hyponatremia. So, we aimed to assess portal hemodynamic changes in hyponatremic Egyptian cirrhotic patients. Patients and Methods: one hundred and sixty cirrhotic patients due to viral causes with or without bilharziasis were included in the study, 125 males and 35 females with mean age of 50.7 years. Patients were divided into 2 groups, Group I 80 hyponatremic patients with serum Na 130mmol/L. All patients were exposed to full history taking, clinical examination, laboratory investigations, abdominal ultrasonography (US) with Doppler study of portal circulation and upper GIT endoscopy and followed during their stay in hospital. Results: Serum sodium had a statistically significant positive correlation with mean portal vein (PV) velocity (r = 0.252, p= 0.001) and a highly statistically significant negative correlation with Mean flow volume, portal vein congestive index (PVCI) and hepatic artery resistive index(Hepatic A RI) (r = -0.593, r = -0.477 and, r = -0.490 respectively with p< 0.001 for all). Analysis of the receiver operating characteristic (ROC) curve revealed that portal vein congestive index was the most sensitive indicator and hepatic artery resistive index was the most specific indicator for prediction of mortality in hyponatremia patients. MELD-Na score was the most sensitive indicator and portal vein congestive index was the most specific indicator for hepatic encephalopathy prediction in hyponatremia patients. Conclusion: Hyponatremic patients had statistically significant portal hemodynamic changes with increased morbidity and mortality in them.
Highlights
Decompensated cirrhotic patients usually have severe complications which have great impact on the progression of cirrhosis and on their quality of life [1]
Analysis of the receiver operating characteristic (ROC) curve revealed that portal vein congestive index was the most sensitive indicator and hepatic artery resistive index was the most specific indicator for prediction of mortality in hyponatremia patients
Pathophysiology of hyponatremia is related mainly to the abnormalities in systemic hemodynamics that is attributed to defect in the renal capacity to excrete solute-free water which leads to retention of water that is disproportionate to the retention of sodium
Summary
Decompensated cirrhotic patients usually have severe complications which have great impact on the progression of cirrhosis and on their quality of life [1]. "Hyponatremia in patients with cirrhosis is demarcated as serum sodium level less130 mEq/L" It is a common finding in cirrhotic patients, and usually associated with multiple clinical manifestations and a poor prognosis [2, 3]. Pathophysiology of hyponatremia is related mainly to the abnormalities in systemic hemodynamics that is attributed to defect in the renal capacity to excrete solute-free water which leads to retention of water that is disproportionate to the retention of sodium. This leads to decrease in serum sodium level and hypoosmolality. We aimed to assess portal hemodynamic changes in hyponatremic Egyptian cirrhotic patients
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