Hyponatremia is a risk factor of hepatic encephalopathy in patients with cirrhosis: A prospective study with time-dependent analysis

Mónica Guevara*, M. E. Baccaro, Aldo Torre, Beatriz Gómez-Ansón, José Ríos, Ferrán Torres, Lorena Rami, Gemma C. Monté-Rubio, Marta Martín-Llahí, Vicente Arroyo, Pere Ginès

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

147 Citations (Scopus)

Abstract

OBJECTIVES:The aim of this study was to investigate whether hyponatremia is a risk factor of overt hepatic encephalopathy (HE) in cirrhosis.METHODS:A total of 61 patients with cirrhosis were evaluated prospectively for 1 year and all episodes of overt HE were recorded. Predictive factors of HE were analyzed using a conditional model (Prentice, Williams, and Peterson) for recurrent events to assess the relationship between HE and time-dependent covariates. The effects of hyponatremia on the brain concentration of organic osmolytes were analyzed in 25 patients using 1H-magnetic resonance spectroscopy.RESULTS:Twenty- eight of the 61 patients developed 57 episodes of overt HE during follow-up. Among a number of clinical and laboratory variables analyzed, the only independent predictive factors of overt HE were hyponatremia (serum sodium <130mEql), history of overt HE, serum bilirubin, and serum creatinine. Hyponatremia was associated with low brain concentration of organic osmolytes, particularly myo-inositol (MI). Furthermore, patients with low brain MI levels had a higher probability of development of overt HE compared with that of patients with high brain MI levels.CONCLUSIONS:In patients with cirrhosis, the existence of hyponatremia is a major risk factor of the development of overt HE. Treatment of hyponatremia may be a novel therapeutic approach to preventing HE in cirrhosis.

Original languageAmerican English
Pages (from-to)1382-1389
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume104
Issue number6
DOIs
Publication statusPublished - Jun 2009

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