FREQUENCY OF HYPONATREMIA AMONG PATIENTS WITH HEPATIC ENCEPHALOPATHY AND SEVERITY OF LIVER DISEASE

Abstract

Background: Hyponatremia is a frequent complication of cirrhosis, as well as a significant cause of the development and progression of hepatic encephalopathy (HE). A deficiency in serum sodium augments the brain edema and worsens the dysfunction of the nervous system. Even though the clinical significance of hyponatremia is high, most settings have not studied the prevalence of this disease and how it correlates with the extent of liver disease.

Objectives: To establish the frequency of hyponatremia in patients with hepatic encephalopathy and the correlation between the hyponatremia and the severity of liver disease in Child-Pugh classification, and in the MELD-Na scores.

Methods: It was a cross-sectional study of analysis that entailed the use of adult patients who were admitted to the Lady Reading Hospital, Peshawar with hepatic encephalopathy and had cirrhosis. The demographic, clinical, and laboratory data were collected, including serum sodium, bilirubin, INR, creatinine, and albumin. A hyponatremia was defined as less than 135mmol/L of serum sodium and was characterized as mild(130134), moderate (125129), or severe (<125). West Haven criteria were applied to score HE, and the severity of the liver disease was established with the assistance of the Child-Pugh class and the MELD-Na as statistical tests. The statistical tests were chi-square, ANOVA, Kruskal-Wallis, Kendall's Spearman correlation, and logistic regression.

Results: Hyponatremia was detected in more than one-third of patients with hepatic encephalopathy. It was quite prevalent in patients with high-grade HE (III and IV). Severe and moderate hyponatremic patients ranked highly on MELD-Na than normonatremic patients (p <0.05). The correlation using Spearman revealed that the relationships between serum sodium and MELD-Na score were very negative. Logistic regression revealed that HE grade, elevated bilirubin, increased INR, renal impairment, ascites, and diuretic use were independent predictors of moderate-severe hyponatremia.

Conclusion: Hyponatremia is common in cirrhotic patients having hepatic encephalopathy, and is closely related to the severity of both neurological and progressive liver disease. The risk of severe encephalopathy cases and even improved clinical outcomes in this high-risk group could be achieved through frequent monitoring and early correction of serum sodium.