Serum sodium and hydration status predict transplant-free survival independent of MELD score in patients with cirrhosis

[Guest guest]

http://www.ingentaconnect.com/content/bsc/jgh/2008/00000023/00000002/art00015;jsessionid=11mdf6vmsphcm.alexandra

Serum sodium and hydration status predict transplant-free survival independent of MELD score in patients with cirrhosis

Authors: Mathur, Sachin1; Gane, J; McCall, L2; Plank, D1

Source: Journal of Gastroenterology and Hepatology, Volume 23, Number 2, February 2008 , pp. 239-243(5)

Publisher: Blackwell Publishing

Abstract:Background and Aim:  Serum sodium may have prognostic value in addition to the model for end-stage liver disease (MELD) score for prediction of early mortality in patients listed for liver transplant. In patients with cirrhosis, over-hydration is a common feature but its prognostic value has not been evaluated. This study examines the independent prognostic significance of MELD, serum sodium and hydration status on long-term survival in patients with cirrhosis. Methods:  Serum sodium and hydration (total body water as a percentage of fat-free mass) were measured in 227 consecutive cirrhotic patients (146 male, 81 female; median age 49 years, range 19-73 years; median MELD score 13, range 6-36). Patients with hepatocellular carcinoma or listed for liver transplantation at the time of initial assessment were excluded. A competing risks proportional hazards analysis was performed to evaluate the influence of MELD, sodium and hydration on risk of death or transplant. Results:  Median follow-up was 52 (range 4-93) months. Serum sodium and hydration were each associated with reduction in time to death or transplant on univariate analysis (sodium: hazard ratio

---

0.90, 95% confidence interval [CI] 0.87-0.94, P < 0.0001; hydration: HR 1.20, 95% CI 1.10-1.30, P < 0.0001). On multivariate analysis, MELD, serum sodium and hydration were independently predictive of death or transplant (MELD: HR 1.12, 95% CI 1.06-1.19, P < 0.0001; sodium: HR 0.93, 95% CI 0.87-0.99, P = 0.04; hydration: HR 1.17, 95% CI 1.02-1.33, P = 0.02). Conclusions:  In non-waitlisted patients with cirrhosis, serum sodium is predictive of transplant or death independent of MELD score.

Keywords: cirrhosis; end-stage liver disease; liver transplantation; total body water

Document Type: Research article

DOI: 10.1111/j.1440-1746.2007.04891.x

Affiliations: 1: Department of Surgery, University of Auckland, and the 2: New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand