Title: Association between Serum Sodium Level and Severity of Complications in Liver Cirrhosis
Authors: Ahmed Amin Ibrahim MD, Waleed Mohammad El Nabawy MD, Mohamed Ibrahim Atta MD, Mohamed Nabil Salem MD, Mahmoud Naiem
DOI: https://dx.doi.org/10.18535/jmscr/v5i1.141
Abstract
Background: Cirrhosis is the end result of chronic liver injury from a variety of causes. It is well recognized in many studies that complicated liver cirrhosis is accompanied by hyponatremia. Hyponatremia is a common abnormal finding in approximately 57% of hospitalized patients with chronic liver disease and in 40% of outpatients with liver disease.
Aim of work: The purpose of the present work is to study the association between serum sodium level and the severity of complications in liver cirrhosis
Subjects and Methods: One hundred patients with complicated liver cirrhosis will be randomly selected from Internal Medicine department and classified according to Child-Pugh class and one fifty uncomplicated chronic liver disease individuals served as a control, Patients with hepatocellular carcinoma, any other malignancy or other major organ failure presented at admission and during the follow up, also patients taking antiviral drugs were excluded. Complications included ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, esophageal and gastric varices, were classified based on severity. All patients and controls in this study were subjected to: Complete history taking, Complete Physical examination All Laboratory routine investigations, Abdominal Ultrasound and upper endoscopy. Patient were classified into groups according the previous Child Pugh classification as 5 patients of the complicated group (5.0%) were Child-Pugh A, 34 were B (34%) and 61 were C (61%), while in the control group 50 persons were child A (100) and no one was classified as child B or C.
Results: Assessing the serum level among the two groups revealed a highly significant difference between the two studied groups and a significant positive correlation was observed between serum sodium level and Child-Pugh score, abdominal ascites, encephalopathy and SBP, HRS, however, no correlation was detected between serum sodium level and, esophegeal varices and fundal varices.
Conclusion: There is conclusive evidence that Hyponatremia, especially serum levels <130 mmol/L, may indicate the existence of severe complications associated with liver cirrhosis esp. ascites, HRS, SBP and hepatic encephalopathy.
Keywords: liver cirrhosis, Child-Pugh, serum sodium, Ascites, Varices.
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