Objective: To evaluate the frequency, clinical associations and prognostic impact of hyponatraemia on cirrhosis related complications in patients with cirrhosis of liver.
Methods: In this case control study 217 cirrhotic patients consecutively admitted to our department from September 2006 to November 2007 were studied. Serum sodium levels were determined in all patients admitted. The cutoff level of 130 meq/l was chosen because it is widely accepted to define hyponatraemia in patients with cirrhosis while the level of 135 meq/L is the lower normal value. Patients were grouped on the basis of serum sodium concentration into (1) serum sodium <130 meq/L (Group 1) (2) serum sodium between 131 - 135 meq/l (Group 2), and (3) serum sodium >135 meq/l (Group 3). P values of less than 0.05 were considered as significant. The patients with hyponatraemia Group 1 (<130 meq/l) and group 2 (131-135 meq/l) were compared with group 3 (>135 meq/l) for the severity of liver disease, degree of ascites and other cirrhosis related complications such as hepatorenal syndrome, spontaneous bacterial peritonitis and hepatic encephalopathy.
Results: This case control study constituted 217 consecutive cirrhotic patients of which 141 (65%) were male and 76/217 (35%) were female. Hyponatraemia (sodium <130 meq/l) was found in 58/217 (26.7%) patients and 54/217 (24.9%) had serum sodium from 131-135 meq/l whereas 105/217 (48.4%) patients had serum sodium >135. Out of 58 patients with hyponatraemia, 48 were in Child-Pugh C class (p=0.001). Patients with serum sodium <130 meq/l had more severe ascites (p = 0.001) requiring frequent paracentesis and higher dosages of diuretics. Hepatic encephalopathy was more frequent in patients with serum sodium <130 meq/l (p= 0.001). The cirrhosis related complications were also significantly increased in patients with mild hyponatraemia (131-135 meq/l) than in patients with normal serum sodium (>135 meq/l).
Conclusion: Hyponatraemia is frequent in cirrhotic patients. It is seldom spontaneous and has a negative influence on cirrhosis related complications.