Sirozlu hastalarda asit sodyum seviyesinin prognostik kullanımı

Year 2021, Volume: 20 Issue: 2, 87 - 93, 26.08.2021

Mustafa Kaplan İhsan Ateş Meral Akdoğan Sabite Kaçar Volkan Gökbulut Orhan Coşkun

https://doi.org/10.17941/agd.977865

Abstract

Giriş ve Amaç: Bu çalışmada, asit sodyum düzeyinin prognostik amaçlarla kullanılabilirliği ve iki yıllık mortalite, spontan bakteriyel peritonit, hepatik ensefalopati ve hepatorenal sendrom ile ilişkisi araştırıldı. Gereç ve Yöntem: Bu çalışma Temmuz ve Ekim 2018 tarihleri arasında karaciğer sirozu olup asit sodyum düzeyi çalışılan hastalarla yapıldı. Şiddetli kalp yetmezliği, nefrotik sendrom veya elektrolit bozukluğu olan hastalar; başvuru sırasında spontan bakteriyel peritonit, hepatik ensefalopati veya hepatorenal sendromu olan hastalar ve başka bir nedenden ötürü diüretik kullanan hastalar çalışma dışı bırakıldı. Bulgular: Çalışma 72 sirotik hasta ile yapıldı [32 kadın (%44.4) ve 40 erkek (%55.6)]. Hastalar iki yıl boyunca takip edildi ve 33 hastada mortalite gelişti (%45.8). 13 hastada hepatik ensefalopati (%18.1), 13 hastada hepatorenal sendrom (%18.1) ve 32 hastada spontan bakteriyel peritonit (%44.4) gelişti. Hepatik ensefalopati, hepatorenal sendrom ve spontan bakteriyel peritonit gelişme oranı derin hiponatremi grubunda diğer hiponatremi gruplarına göre daha yüksekti (p < 0.05). Ortalama Child-Pugh ve Model for End-Stage Liver Disease-Na skorları orta ve derin hiponatremi gruplarında diğer gruplara göre daha yüksekti (p < 0.05). Asit sıvısında hiponatremi mortalite için bağımsız bir prediktör olarak bulundu ve mortalite riski derin hiponatremisi olan hastalarda hiponatremi olmayan hastalara göre 29.55 kat daha fazla bulundu. Sonuç: Bu çalışmada asit sıvısında 125 mEq/L’den daha düşük sodyum düzeyi ile artmış sirotik komplikasyonlar ve mortalite arasında ilişki olduğu gösterilmiştir.

Keywords

Hiponatremi, hepatik ensefalopati, hepatorenal sendrom, spontan bakteriyel peritonit

The prognostic utility of ascites sodium level in cirrhotic patients

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.

Keywords

Hyponatremia, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis

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