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

AuthorsGuevara, Mónica; Baccaro, María Eugenia; Torre, Aldo; Gómez-Anson, Beatriz; Ríos, José; Torres, Ferran; Rami, Lorena; Monté-Rubio, Gemma C.; Martín-Llahí, Marta; Arroyo, Vicente; Ginès, Pere
Issue Date2009
PublisherNature Publishing Group
CitationAmerican Journal of Gastroenterology 104(6): 1382-1389 (2009)
AbstractOBJECTIVES: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. © 2009 by the American College of Gastroenterology.
Identifiersdoi: 10.1038/ajg.2009.293
issn: 0002-9270
e-issn: 1572-0241
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