Clinical relevance of hyponatraemia for the hospital outcome of cirrhotic patients

Background. Hyponatraemia frequently develops in cirrhotic patients whose ability to excrete free water is impaired. The role of hyponatraemia in the prognosis of such patients is unclear. Aim. To evaluate prevalence, clinical associations and prognostic impact of hyponatraemia in cirrhotic inpatients. Patients. A series of 156 cirrhotic patients consecutively admitted to our department, for a total of 191 admissions, were studied. Methods. Serum sodium levels were determined at admission and repeated at least weekly in all patients. The clinical status and the survival of patients with hyponatraemia (≤130 mmol/l) were compared to those of patients with normal sodium levels. Results. Hyponatraemia was found in 57 out of 191 admissions (29.8%). Bacterial infections, ascites, chronic diuretic therapy, but not gastrointestinal bleeding or renal failure, were more frequent in patients with hyponatraemia than in those with normal sodium levels. In 3 cases, none of these conditions were present and hyponatraemia was defined as ″spontaneous″. Hospital death rate was increased in patients with hyponatraemia (26.3% versus 8.9%, χ²=8.55, p=0.003). By multivariate analysis, the only parameters meters independently associated with survival were high serum bilirubin (p=0.006) and high serum urea levels (p=0.019). Twenty-five patients developed severe hyponatraemia (