medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2018, Number 5

<< Back Next >>

Ann Hepatol 2018; 17 (5)

Serum Electrolyte Levels and Outcomes in Patients Hospitalized with Hepatic Encephalopathy

Alsaad AA, Stancampiano FF, Palmer WC, Henry AM, Jackson JK, Heckman MG, Diehl NN, Keaveny AP

Language: English
References: 20
Page: 836-842
PDF size: 147.67 Kb.


ABSTRACT

Introduction and aims. Serum electrolyte derangements are common in patients with decompensated cirrhosis hospitalized for hepatic encephalopathy. There are limited data describing the association between electrolyte levels and outcomes in hepatic encephalopathy. We assessed the association between initial serum electrolyte values and outcomes in patients with hepatic encephalopathy. Material and methods. A total of 385 consecutive patients hospitalized with encephalopathy were included in the study. Baseline electrolyte levels (sodium, potassium, chloride, bicarbonate, calcium and phosphorus) were measured at the time of admission and assessed for association with outcomes, which included survival, admission to the intensive care unit, requirement for mechanical ventilation, and length of hospital stay. P-values ≤ 0.0083 were considered significant after adjustment for multiple testing. Results. In unadjusted analysis, significant associations were identified regarding both bicarbonate and phosphorus (admission to intensive care unit), and calcium (mechanical ventilation); however these findings weakened and no longer approached statistical significance when adjusting for confounding variables. No other significant associations between serum electrolyte measurements and outcomes were observed. Conclusions. Our findings suggest that in patients hospitalized with encephalopathy, serum electrolyte measurements are not strong predictors of patient outcome.


REFERENCES

  1. Aldworth G. Hepatic encephalopathy. Ann Clin Biochem 2017; 54: 416.

  2. Weiss N, Jalan R, Thabut D. Understanding hepatic encephalopathy. Intensive Care Med 2018; 44: 231-4.

  3. Wijdicks EF. Hepatic Encephalopathy. N Engl J Med 2016; 375: 1660-70.

  4. Tapper EB, Jiang ZG, Patwardhan VR. Refining the ammonia hypothesis: a physiology-driven approach to the treatment of hepatic encephalopathy. Mayo Clin Proc 2015; 90: 646-58.

  5. Tamaoki S, Suzuki H, Okada M, Fukui N, Isobe M, Saito T. Development of an experimental rat model of hyperammonemic encephalopathy and evaluation of the effects of rifaximin. Eur J Pharmacol 2016; 779: 168-76.

  6. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014; 60: 715-35.

  7. Han KH. Mechanisms of the effects of acidosis and hypokalemia on renal ammonia metabolism. Electrolyte Blood Press 2011; 9: 45-9.

  8. Iwasa M, Sugimoto R, Mifuji-Moroka R, Hara N, Yoshikawa K, Tanaka H, Eguchi A, et al. Factors contributing to the development of overt encephalopathy in liver cirrhosis patients. Metab Brain Dis 2016; 31: 1151-6.

  9. Pantham G, Post A, Venkat D, Einstadter D, Mullen KD. A New Look at Precipitants of Overt Hepatic Encephalopathy in Cirrhosis. Dig Dis Sci 2017; 62: 2166-73.

  10. Fichet J, Mercier E, Genee O, Garot D, Legras A, Dequin PF, Perrotin D. Prognosis and 1-year mortality of intensive care unit patients with severe hepatic encephalopathy. J Crit Care 2009; 24: 364-70.

  11. Bajaj JS, O’Leary JG, Tandon P, Wong F, Garcia-Tsao G, Kamath PS, Maliakkal B, et al. Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures. Clin Gastroenterol Hepatol 2017; 15: 565-74 e564.

  12. Rassameehiran S, Mankongpaisarnrung C, Sutamtewagul G, Klomjit S, Rakvit A. Predictor of 90-Day Readmission Rate for Hepatic Encephalopathy. South Med J 2016; 109: 365-9.

  13. Cordoba J, Garcia-Martinez R, Simon-Talero M. Hyponatremic and hepatic encephalopathies: similarities, differences and coexistence. Metab Brain Dis 2010; 25: 73-80.

  14. Montagnese S, Angeli P, Craxi A. Between reality and the guidelines: A survey on perception, diagnosis and manage ment of hepatic encephalopathy in 201 Italian specialist centres. Dig Liver Dis 2017; 49: 828-30.

  15. Guevara M, Baccaro ME, Rios J, Martin-Llahi M, Uriz J, Ruiz del Arbol L, Planas R, et al. Risk factors for hepatic encephalopathy in patients with cirrhosis and refractory ascites: relevance of serum sodium concentration. Liver Int 2010; 30: 1137-42.

  16. Guevara M, Gines P. [Hyponatremia in liver cirrhosis: pathogenesis and treatment]. Endocrinol Nutr 2010; 57(Suppl. 2): 15-21.

  17. Categorical Data Analysis With SAS and SPSS Applications (Book). Sci-Tech News 2003; 57: 66.

  18. Harrell FE. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York: Springer; 2001; xxii, p. 568.

  19. Guevara M, Baccaro ME, Torre A, Gomez-Anson B, Rios J, Torres F, Rami L, et al. Hyponatremia is a risk factor of hepatic encephalopathy in patients with cirrhosis: a prospective study with time-dependent analysis. Am J Gastroenterol 2009; 104: 1382-9.

  20. Qureshi MO, Khokhar N, Saleem A, Niazi TK. Correlation of hyponatremia with hepatic encephalopathy and severity of liver disease. J Coll Physicians Surg Pak 2014; 24: 135-7.




2020     |     www.medigraphic.com