Jasmohan S Bajaj1, Puneeta Tandon1, Jacqueline G OʼLeary1, Scott W Biggins1,1, Florence Wong1, Patrick S Kamath1, Guadalupe Garcia-Tsao1, Benedict Maliakkal1,1, Jennifer C Lai1, Michael Fallon1,1, Paul Thuluvath1, Hugo E Vargas1, Ram M Subramanian1, Leroy R Thacker1, Rajender K Reddy1. 1. Virginia Commonwealth university and McGuire VA Medical Center, Richmond, VA, uSA. university of Alberta, Edmonton, AB, Canada. Dallas VA Medical Center and Baylor University Medical Center, Dallas, TX, USA. University of Washington, Seattle, WA, USA. University of Denver, Colorado, CO, USA. University of Toronto, Toronto, ON, Canada. Mayo Clinic, Rochester, MN, USA. Yale University Medical Center, West Haven, CT, USA. University of Tennessee, Memphis, TN, USA. University of Rochester, Rochester, NY, USA. University of California, San Francisco, CA, USA. University of Arizona, Phoenix, AZ, USA. University of Texas, Houston, TX, USA. Mercy Medical Center, Baltimore, MD, USA. Mayo Clinic, Scottsdale, AZ, USA. Emory University Medical Center, Atlanta, GA, USA. University of Pennsylvania, Philadelphia, PA, USA.
Abstract
OBJECTIVES: Hyponatremia is associated with poor outcomes in cirrhosis independent of MELD. While intravenous albumin has been used in small series, its role in hyponatremia is unclear. The aim of this study is to determine the effect of albumin therapy on hyponatremia. METHODS: Hospitalized cirrhotic patients included in the NACSELD (North American Consortium for End-Stage Liver Disease) cohort with hyponatremia (Na <130mmol/L) were divided into those receiving intravenous albumin or not. Determinants of hyponatremia resolution (Na ≥135 meq/L) and 30-day survival were analyzed using regression and ANCOVA models. RESULTS: Overall, 2435 patients, of whom 1126 had admission hyponatremia, were included. Of these, 777 received 225 (IQR 100,400) g of albumin, while 349 did not. Patients given albumin had a higher admission MELD score, and serum creatinine and lower admission Na and mean arterial pressure (MAP). However they experienced a higher maximum Na and hyponatremia resolution (69% vs 61%, p = 0.008) compared to those who did not. On regression, delta Na was independently associated with admission creatinine, MAP and albumin use. On ANCOVA with logistic regression, there was a significant difference in hyponatremia resolution between those who did or did not receive albumin, even after adjustment for admission Na and GFR (85.41% vs 44.78%, p = 0.0057, OR: 1.50 95% CI: 1.13-2.00). Independent predictors of 30-day survival were hyponatremia resolution, age, ACLF, and admission GFR. CONCLUSION: Hospitalized patients with cirrhosis and hyponatremia who received intravenous albumin had a higher rate of hyponatremia resolution independent of renal function and baseline sodium levels, which was in turn associated with a better 30-day survival.
OBJECTIVES:Hyponatremia is associated with poor outcomes in cirrhosis independent of MELD. While intravenous albumin has been used in small series, its role in hyponatremia is unclear. The aim of this study is to determine the effect of albumin therapy on hyponatremia. METHODS: Hospitalized cirrhotic patients included in the NACSELD (North American Consortium for End-Stage Liver Disease) cohort with hyponatremia (Na <130mmol/L) were divided into those receiving intravenous albumin or not. Determinants of hyponatremia resolution (Na ≥135 meq/L) and 30-day survival were analyzed using regression and ANCOVA models. RESULTS: Overall, 2435 patients, of whom 1126 had admission hyponatremia, were included. Of these, 777 received 225 (IQR 100,400) g of albumin, while 349 did not. Patients given albumin had a higher admission MELD score, and serum creatinine and lower admission Na and mean arterial pressure (MAP). However they experienced a higher maximum Na and hyponatremia resolution (69% vs 61%, p = 0.008) compared to those who did not. On regression, delta Na was independently associated with admission creatinine, MAP and albumin use. On ANCOVA with logistic regression, there was a significant difference in hyponatremia resolution between those who did or did not receive albumin, even after adjustment for admission Na and GFR (85.41% vs 44.78%, p = 0.0057, OR: 1.50 95% CI: 1.13-2.00). Independent predictors of 30-day survival were hyponatremia resolution, age, ACLF, and admission GFR. CONCLUSION: Hospitalized patients with cirrhosis and hyponatremia who received intravenous albumin had a higher rate of hyponatremia resolution independent of renal function and baseline sodium levels, which was in turn associated with a better 30-day survival.
Authors: W Ray Kim; Ajitha Mannalithara; Julie K Heimbach; Patrick S Kamath; Sumeet K Asrani; Scott W Biggins; Nicholas L Wood; Sommer E Gentry; Allison J Kwong Journal: Gastroenterology Date: 2021-09-03 Impact factor: 22.682
Authors: Rosa G Simonetti; Giovanni Perricone; Dimitrinka Nikolova; Goran Bjelakovic; Christian Gluud Journal: Cochrane Database Syst Rev Date: 2019-06-28
Authors: Guruprasad P Aithal; Naaventhan Palaniyappan; Louise China; Suvi Härmälä; Lucia Macken; Jennifer M Ryan; Emilie A Wilkes; Kevin Moore; Joanna A Leithead; Peter C Hayes; Alastair J O'Brien; Sumita Verma Journal: Gut Date: 2020-10-16 Impact factor: 23.059