Sirozlu hastalarda asit sodyum seviyesinin prognostik kullanımı

Abstract

Background and Aims: In this study, we investigated the usefulness of the ascites sodium level for prognostic purposes and its association with 2-year mortality, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome. Material and Methods: This study was performed between July and October 2018 in patients with liver cirrhosis in whom the ascites sodium level was studied. Patients with severe heart failure, nephrotic syndrome, or electrolyte disturbance; patients who had spontaneous bacterial peritonitis, hepatic encephalopathy or hepatorenal syndrome at admission; and patients who used diuretics for another reason were excluded from the study. Results: The study population consisted of 72 cirrhotic patients [32 females (44.4%) and 40 males (55.6%)]. The patients were followed up for 2 years, and mortality developed in 33 patients (45.8%). During follow-up, hepatic encephalopathy developed in 13 patients (18.1%), hepatorenal syndrome in 13 patients (18.1%), and spontaneous bacterial peritonitis in 32 patients (44.4%). Hepatic encephalopathy, hepatorenal syndrome, and the spontaneous bacterial peritonitis ratio were higher in the deep hyponatremia group compared with other hyponatremia groups (p < 0.05). The mean Child-Pugh and Model for End-Stage Liver Disease-Na scores were similar in the moderate and deep hyponatremia groups, and they were higher than in the other groups (p < 0.05). The mortality rate was found to be higher in the deep hyponatremia group than in the other hyponatremia groups (p < 0.05). Hyponatremia in ascites was found to be an independent predictor of mortality, and patients in the deep hyponatremia group had a 29.55-fold increased risk of mortality compared with those patients without hyponatremia. Conclusion: In this study, it was shown that deep hyponatremia less than 125 mEq/L in ascites was associated with increased cirrhotic complications and mortality.