Agustos 2021
Sirozlu hastalarda asit sodyum seviyesinin prognostik kullanimi
The prognostic utility of ascites sodium level in cirrhotic patients
- Ana Sayfa
- Sayılar
- Agustos 2021
- Sirozlu hastalarda asit sodyum seviyesinin prognostik kullanimi...
Departments of 2Internal Medicine and 3Gastroenterology, Ministry of Health Ankara City Hospital, Ankara, Turkey
Özet
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
Abstract
Giris ve Amaç: Bu çalismada, asit sodyum düzeyinin prognostik amaç- larla kullanilabilirligi ve iki yillik mortalite, spontan bakteriyel peritonit, hepatik ensefalopati ve hepatorenal sendrom ile iliskisi arastirildi. Gereç ve Yöntem: Bu çalisma Temmuz ve Ekim 2018 tarihleri arasinda karaciger sirozu olup asit sodyum düzeyi çalisilan hastalarla yapildi. Siddetli kalp yetmezligi, nefrotik sendrom veya elektrolit bozuklugu olan hastalar; basvuru sirasinda spontan bakteriyel peritonit, hepatik ensefalopati veya hepatorenal sendromu olan hastalar ve baska bir nedenden ötürü diüretik kullanan hastalar çalisma disi birakildi. Bulgular: Çalisma 72 sirotik hasta ile yapildi [32 kadin (%44.4) ve 40 erkek (%55.6)]. Hastalar iki yil boyunca takip edildi ve 33 hastada mortalite gelisti (%45.8). 13 hastada hepatik ensefalopati (%18.1), 13 hastada hepatorenal sendrom (%18.1) ve 32 hastada spontan bakteriyel peritonit (%44.4) gelisti. Hepatik ensefalopati, hepatorenal sendrom ve spontan bakteriyel peritonit gelisme orani derin hiponatremi grubunda diger hiponatremi gruplarina göre daha yüksekti (p < 0.05). Ortalama Child-Pugh ve Model for End-Stage Liver Disease-Na skorlari orta ve derin hiponatremi gruplarinda diger gruplara göre daha yüksekti (p < 0.05). Asit sivisinda hiponatremi mortalite için bagimsiz bir prediktör olarak bulundu ve mortalite riski derin hiponatremisi olan hastalarda hiponatremi olmayan hastalara göre 29.55 kat daha fazla bulundu. Sonuç: Bu çalismada asit sivisinda 125 mEq/L’den daha düsük sodyum düzeyi ile artmis sirotik komplikasyonlar ve mortalite arasinda iliski oldugu gösterilmistir.
