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Hyponatremia Is a Risk Factor of Hepatic Encephalopathy in Patients With Cirrhosis: A Prospective Study With Time-Dependent Analysis

2009; Lippincott Williams & Wilkins; Volume: 104; Issue: 6 Linguagem: Inglês

10.1038/ajg.2009.293

1572-0241

Mónica Guevara, María E. Baccaro, Aldo Torre, Beatriz Gómez‐Ansón, José Ríos, Ferrán Torres, Lorena Rami, Gemma C. Monté, Marta Martín–Llahí, Vicente Arroyo, Pere Ginès,

Liver Disease Diagnosis and Treatment

The aim of this study was to investigate whether hyponatremia is a risk factor of overt hepatic encephalopathy (HE) in cirrhosis.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 1 H-magnetic resonance spectroscopy.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 < 130 mEq / l), 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.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.