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Sirozlu hastalarda asit sodyum seviyesinin prognostik kullanımı

Yıl 2021, Cilt: 20 Sayı: 2, 87 - 93, 26.08.2021
https://doi.org/10.17941/agd.977865

Öz

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.

Kaynakça

  • 1- Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet 2014;383:1749-61.
  • 2- Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: A systematic review and meta-analysis of observational studies. Medicine (Baltimore) 2016;95:e2877.
  • 3- Puentes JCP, Rocha H, Nicolau S, Ferrão G. Effectiveness of the MELD/Na score and the Child-Pugh score for the identification of palliative care needs in patients with cirrhosis of the liver. Indian J Palliat Care 2018;24:526-8.
  • 4- Benedeto-Stojanov D, Nagorni A, Bjelaković G, Stojanov D, et al. The model for the end-stage liver disease and Child-Pugh score in predicting prognosis in patients with liver cirrhosis and esophageal variceal bleeding. Vojnosanit Pregl 2009;66:724-8.
  • 5- Biggins SW, Rodriguez HJ, Bacchetti P, et al. Serum sodium predicts mortality in patients listed for liver transplantation. Hepatology 2005;41:32-9.
  • 6- Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008;359:1018-26.
  • 7- Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentrationinto MELD. Gastroenterology 2006;130:1652-60.
  • 8- John S, Thuluvath PJ. Hyponatremia in cirrhosis: pathophysiology and management. World J Gastroenterol 2015;21:3197-205.
  • 9- Barakat AA, Metwaly AA, Nasr FM, et al. Impact of hyponatremia on frequency of complications in patients with decompensated liver cirrhosis. Electron Physician 2015;7:1349-58.
  • 10- Angeli P, Wong F, Watson H, Ginès P; CAPPS Investigators. Hyponatremia in cirrhosis: results of a patient population survey. Hepatology 2006;44:1535-42.
  • 11- Asrani SK, Kamath PS, Natural history of cirrhosis. Curr Gastroenterol Rep 2013;15:308.
  • 12- Zhu FL, Ling AS, Wei Q, Ma J, Lu G. Tumor markers in serum and ascites in the diagnosis of benign and malignant ascites. Asian Pac J Cancer Prev 2015;16:719-22.
  • 13- Bajaj JS, Wade JB, Sanyal AJ. Spectrum of neurocognitive impairment in cirrhosis: Implications for the assessment of hepatic encephalopathy. Hepatology (Baltimore, Md) 2009;50:2014-21.
  • 14- Rimola A, García-Tsao G, Navasa M, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000;32:142-53.
  • 15- Arroyo V, Ginès P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996;23:164-76.
  • 16- Elwir S, Rahimi RS. Hepatic encephalopathy: An update on the pathophysiology and therapeutic options. J Clin Transl Hepatol 2017;5:142-51.
  • 17- Bustamante J, Rimola A, Ventura PJ, et al. Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol 1999;30:890-5.
  • 18- Iwasa M, Takei Y. Pathophysiology and management of hepatic encephalopathy 2014 update: Ammonia toxicity and hyponatremia. Hepatol Res 2015;45:1155-62.
  • 19- Shah N, Silva RG, Kowalski A, Desai C, Lerma E. Hepatorenal syndrome. Dis Mon 2016;62:364-75.
  • 20- Dever JB, Sheikh MY. Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther 2015;41:1116-31.
  • 21- Samuel D. MELD-Na as a prognostic score for cirrhotic patients: Hyponatremia and ascites are back in the game. J Hepatol 2009;50:836-8.
  • 22- Runyon BA, Montano AA, Akriviadis EA, et al. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med 1992;117:215-20.
  • 23- Gokturk HS, Demir M, Ozturk NA, et al. The role of ascitic fluid viscosity in the differential diagnosis of ascites. Can J Gastroenterol 2010;24:255-9.
  • 24- Zhu FL, Ling AS, Wei Q, Ma J, Lu G. Tumor markers in serum and ascites in the diagnosis of benign and malignant ascites. Asian Pac J Cancer Prev.2015;16:719-22.
  • 25- Huang LL, Xia HH, Zhu SL. Ascitic fluid analysis in the differential diagnosis of ascites: focus on cirrhotic ascites. J Clin Transl Hepatol 2014;2:58-64.

The prognostic utility of ascites sodium level in cirrhotic patients

Yıl 2021, Cilt: 20 Sayı: 2, 87 - 93, 26.08.2021
https://doi.org/10.17941/agd.977865

Öz

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.

Kaynakça

  • 1- Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet 2014;383:1749-61.
  • 2- Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: A systematic review and meta-analysis of observational studies. Medicine (Baltimore) 2016;95:e2877.
  • 3- Puentes JCP, Rocha H, Nicolau S, Ferrão G. Effectiveness of the MELD/Na score and the Child-Pugh score for the identification of palliative care needs in patients with cirrhosis of the liver. Indian J Palliat Care 2018;24:526-8.
  • 4- Benedeto-Stojanov D, Nagorni A, Bjelaković G, Stojanov D, et al. The model for the end-stage liver disease and Child-Pugh score in predicting prognosis in patients with liver cirrhosis and esophageal variceal bleeding. Vojnosanit Pregl 2009;66:724-8.
  • 5- Biggins SW, Rodriguez HJ, Bacchetti P, et al. Serum sodium predicts mortality in patients listed for liver transplantation. Hepatology 2005;41:32-9.
  • 6- Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008;359:1018-26.
  • 7- Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentrationinto MELD. Gastroenterology 2006;130:1652-60.
  • 8- John S, Thuluvath PJ. Hyponatremia in cirrhosis: pathophysiology and management. World J Gastroenterol 2015;21:3197-205.
  • 9- Barakat AA, Metwaly AA, Nasr FM, et al. Impact of hyponatremia on frequency of complications in patients with decompensated liver cirrhosis. Electron Physician 2015;7:1349-58.
  • 10- Angeli P, Wong F, Watson H, Ginès P; CAPPS Investigators. Hyponatremia in cirrhosis: results of a patient population survey. Hepatology 2006;44:1535-42.
  • 11- Asrani SK, Kamath PS, Natural history of cirrhosis. Curr Gastroenterol Rep 2013;15:308.
  • 12- Zhu FL, Ling AS, Wei Q, Ma J, Lu G. Tumor markers in serum and ascites in the diagnosis of benign and malignant ascites. Asian Pac J Cancer Prev 2015;16:719-22.
  • 13- Bajaj JS, Wade JB, Sanyal AJ. Spectrum of neurocognitive impairment in cirrhosis: Implications for the assessment of hepatic encephalopathy. Hepatology (Baltimore, Md) 2009;50:2014-21.
  • 14- Rimola A, García-Tsao G, Navasa M, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000;32:142-53.
  • 15- Arroyo V, Ginès P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996;23:164-76.
  • 16- Elwir S, Rahimi RS. Hepatic encephalopathy: An update on the pathophysiology and therapeutic options. J Clin Transl Hepatol 2017;5:142-51.
  • 17- Bustamante J, Rimola A, Ventura PJ, et al. Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol 1999;30:890-5.
  • 18- Iwasa M, Takei Y. Pathophysiology and management of hepatic encephalopathy 2014 update: Ammonia toxicity and hyponatremia. Hepatol Res 2015;45:1155-62.
  • 19- Shah N, Silva RG, Kowalski A, Desai C, Lerma E. Hepatorenal syndrome. Dis Mon 2016;62:364-75.
  • 20- Dever JB, Sheikh MY. Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther 2015;41:1116-31.
  • 21- Samuel D. MELD-Na as a prognostic score for cirrhotic patients: Hyponatremia and ascites are back in the game. J Hepatol 2009;50:836-8.
  • 22- Runyon BA, Montano AA, Akriviadis EA, et al. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med 1992;117:215-20.
  • 23- Gokturk HS, Demir M, Ozturk NA, et al. The role of ascitic fluid viscosity in the differential diagnosis of ascites. Can J Gastroenterol 2010;24:255-9.
  • 24- Zhu FL, Ling AS, Wei Q, Ma J, Lu G. Tumor markers in serum and ascites in the diagnosis of benign and malignant ascites. Asian Pac J Cancer Prev.2015;16:719-22.
  • 25- Huang LL, Xia HH, Zhu SL. Ascitic fluid analysis in the differential diagnosis of ascites: focus on cirrhotic ascites. J Clin Transl Hepatol 2014;2:58-64.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Mustafa Kaplan Bu kişi benim 0000-0002-6959-675X

İhsan Ateş Bu kişi benim 0000-0003-2858-6229

Meral Akdoğan Bu kişi benim 0000-0003-4624-2542

Sabite Kaçar Bu kişi benim 0000-0002-3257-3546

Volkan Gökbulut Bu kişi benim 0000-0002-7906-2479

Orhan Coşkun Bu kişi benim 0000-0002-3124-9517

Yayımlanma Tarihi 26 Ağustos 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 20 Sayı: 2

Kaynak Göster

APA Kaplan, M., Ateş, İ., Akdoğan, M., Kaçar, S., vd. (2021). The prognostic utility of ascites sodium level in cirrhotic patients. Akademik Gastroenteroloji Dergisi, 20(2), 87-93. https://doi.org/10.17941/agd.977865

test-5