Sodium handling is associated with liver function impairment and renin-aldosterone axis activity in patients with preascitic cirrhosis without hyponatremia
Dourakis, Spyros P.
Stergiou, George S.
Background In cirrhotic patients awaiting liver transplantation, serum sodium concentrationis related to prognosis. However, abnormalities in sodium homeostasis are evident even in theearly preascitic stage of cirrhosis. We aimed to investigate whether parameters of renal sodiumhandling (serum sodium, urinary sodium and fractional exertion of sodium (FeNa%) correlatewith markers of liver function and renin-aldosterone axis activity in patients with preasciticcirrhosis without hyponatremia.Methods Patients with preascitic cirrhosis without hyponatremia underwent routine blood andurine laboratory tests, including markers of liver function impairment and sodium homeostasis.Results Thirty eight cirrhotic patients (22 men) with mean age of 57.3±12.2 (SD) years wereincluded. Twenty six and twelve patients were at Child-Pugh stage A and B cirrhosis respectively.Eighteen patients had a Model for End-stage Liver Disease (MELD) score of ≤9 and twenty hadMELD >9. Serum sodium was found to differ significantly between Child-Pugh stage A and Bcirrhotics (mean 142.8±2.0 mmol/L vs. 140.5±3.3 mmol/L, p<0.05). Serum sodium was alsofound to differ significantly between patients with MELD score ≤9 and >9 (mean 143.3±2.0mmol/L vs. 140.9±2.8 mmol/L, respectively, p<0.01). Serum sodium correlated negatively withthe international normalized ratio (INR) (r=-0.51, p<0.01), aldosterone (r=-0.40, p<0.05), Child- Pugh and MELD scores (r=-0.34, p<0.05 and r=-0.45, p<0.05 respectively). FeNa% correlated negatively with renin and aldosterone (r=-0.56, p<0.001 and r=-0.50, p<0.01 respectively).Conclusion Serum sodium concentration is a good surrogate marker of liver function impairmentnot only in late-stage liver cirrhosis before transplantation but also in the early preascitic stage.Keywords cirrhosis, liver function markers, serum sodium, Child-Pugh stage, MELD scoreAnn Gastroenterol 2012; 25 (3): 254-257