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Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study.
Crit Care. 2014 Dec 13; 18(6):700.CC

Abstract

INTRODUCTION

Hyponatremia is a marker of poor prognosis in patients with cirrhosis. This analysis aimed to assess if hyponatremia also has prognostic value in patients with acute-on-chronic liver failure (ACLF), a syndrome characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality.

METHODS

We performed an analysis of the Chronic Liver Failure Consortium CANONIC database in 1,341 consecutive patients admitted to 29 European centers with acute decompensation of cirrhosis (including ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infections, or any combination of these), both with and without associated ACLF (301 and 1,040 respectively).

RESULTS

Of the 301 patients with ACLF, 24.3% had hyponatremia at inclusion compared to 12.3% of 1,040 patients without ACLF (P <0.001). Model for end-stage liver disease, Child-Pugh and chronic liver failure-SOFA scores were significantly higher in patients with ACLF and hyponatremia compared to those without hyponatremia. The presence of hyponatremia (at inclusion or during hospitalization) was a predictive factor of survival both in patients with and without ACLF. The presence of hyponatremia and ACLF was found to have an independent effect on 90-day survival after adjusting for the potential confounders. Hyponatremia in non-ACLF patients nearly doubled the risk (hazard ratio (HR) 1.81 (1.33 to 2.47)) of dying at 90 days. However, when considering patients with both factors (ACLF and hyponatremia) the relative risk of dying at 90 days was significantly higher (HR 6.85 (3.85 to 12.19) than for patients without both factors. Patients with hyponatremia and ACLF had a three-month transplant-free survival of only 35.8% compared to 58.7% in those with ACLF without hyponatremia (P <0.001).

CONCLUSIONS

The presence of hyponatremia is an independent predictive factor of survival in patients with ACLF. In cirrhosis, outcome of patients with ACLF is dependent on its association with hyponatremia.

Authors+Show Affiliations

GI Unit, Hospital Clinic, University of Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain. acardena@clinic.ub.es.Liver Unit, Hospital Clinic, University of Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain. esola@clinic.ub.es.Liver Unit, Hospital Clinic, University of Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain. ezrodrig@clinic.ub.es.Liver Unit, Hospital Clinic, University of Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain. rbarreto@clinic.ub.es.Liver Unit, Hospital Clinic, University of Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain. igraupe@clinic.ub.es.Data Management Center - CLIF Consortium, Hospital Clinic, Carrer Villarroel, 170, 08036, Barcelona, Spain. mpavesi@clinic.ub.es.AP-HP Hôpital Paul Brousse Centre Hépato-Biliaire, University Paris-Sud, UMR-S 785, 12 avenue Paul Vaillant Couturier, 94800, Villejuif, France. faouzi.saliba@pbr.aphp.fr.Department of Medicine 1, JW Goethe University Hospital, Frankfurt Theodor-Stern-Kai 7, D-60590, Frankfurt am Main, Germany. Tania.Welzel@kgu.de.Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera. de Colmenar Viejo, km 9100, 28034, Madrid, Spain. martinez.gonzalez.javier@gmail.com.Liver Unit, Department of Gastroenterology and Hepatopancreatology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. Thierry.Gustot@erasme.ulb.ac.be.Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy. mauro.bernardi@unibo.it.Liver Unit, Hospital Clinic, University of Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain. varroyo@clinic.ub.es.Liver Unit, Hospital Clinic, University of Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain. pgines@clinic.ub.es. University of Barcelona, IDIBAPS, CIBEReHD, IRSIN, Carrer Villarroel, 170, 08036, Barcelona, Catalunya, Spain. pgines@clinic.ub.es.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25643318

Citation

Cárdenas, Andrés, et al. "Hyponatremia Influences the Outcome of Patients With Acute-on-chronic Liver Failure: an Analysis of the CANONIC Study." Critical Care (London, England), vol. 18, no. 6, 2014, p. 700.
Cárdenas A, Solà E, Rodríguez E, et al. Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study. Crit Care. 2014;18(6):700.
Cárdenas, A., Solà, E., Rodríguez, E., Barreto, R., Graupera, I., Pavesi, M., Saliba, F., Welzel, T. M., Martinez-Gonzalez, J., Gustot, T., Bernardi, M., Arroyo, V., & Ginès, P. (2014). Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study. Critical Care (London, England), 18(6), 700. https://doi.org/10.1186/s13054-014-0700-0
Cárdenas A, et al. Hyponatremia Influences the Outcome of Patients With Acute-on-chronic Liver Failure: an Analysis of the CANONIC Study. Crit Care. 2014 Dec 13;18(6):700. PubMed PMID: 25643318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study. AU - Cárdenas,Andrés, AU - Solà,Elsa, AU - Rodríguez,Ezequiel, AU - Barreto,Rogelio, AU - Graupera,Isabel, AU - Pavesi,Marco, AU - Saliba,Faouzi, AU - Welzel,Tania Mara, AU - Martinez-Gonzalez,Javier, AU - Gustot,Thierry, AU - Bernardi,Mauro, AU - Arroyo,Vicente, AU - Ginès,Pere, AU - ,, Y1 - 2014/12/13/ PY - 2014/07/08/received PY - 2014/11/27/accepted PY - 2015/2/3/entrez PY - 2015/2/3/pubmed PY - 2016/1/14/medline SP - 700 EP - 700 JF - Critical care (London, England) JO - Crit Care VL - 18 IS - 6 N2 - INTRODUCTION: Hyponatremia is a marker of poor prognosis in patients with cirrhosis. This analysis aimed to assess if hyponatremia also has prognostic value in patients with acute-on-chronic liver failure (ACLF), a syndrome characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality. METHODS: We performed an analysis of the Chronic Liver Failure Consortium CANONIC database in 1,341 consecutive patients admitted to 29 European centers with acute decompensation of cirrhosis (including ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infections, or any combination of these), both with and without associated ACLF (301 and 1,040 respectively). RESULTS: Of the 301 patients with ACLF, 24.3% had hyponatremia at inclusion compared to 12.3% of 1,040 patients without ACLF (P <0.001). Model for end-stage liver disease, Child-Pugh and chronic liver failure-SOFA scores were significantly higher in patients with ACLF and hyponatremia compared to those without hyponatremia. The presence of hyponatremia (at inclusion or during hospitalization) was a predictive factor of survival both in patients with and without ACLF. The presence of hyponatremia and ACLF was found to have an independent effect on 90-day survival after adjusting for the potential confounders. Hyponatremia in non-ACLF patients nearly doubled the risk (hazard ratio (HR) 1.81 (1.33 to 2.47)) of dying at 90 days. However, when considering patients with both factors (ACLF and hyponatremia) the relative risk of dying at 90 days was significantly higher (HR 6.85 (3.85 to 12.19) than for patients without both factors. Patients with hyponatremia and ACLF had a three-month transplant-free survival of only 35.8% compared to 58.7% in those with ACLF without hyponatremia (P <0.001). CONCLUSIONS: The presence of hyponatremia is an independent predictive factor of survival in patients with ACLF. In cirrhosis, outcome of patients with ACLF is dependent on its association with hyponatremia. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/25643318/Hyponatremia_influences_the_outcome_of_patients_with_acute_on_chronic_liver_failure:_an_analysis_of_the_CANONIC_study_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0700-0 DB - PRIME DP - Unbound Medicine ER -