RESUMEN
INTRODUCTION: In the decompensated hepatic cirrhosis the development of complications such as bleeding in the digestive tracts, encephalopathy, ascites and spontaneous bacterial peritonitis is well-known; another important complication is the development of dilutional hyponatremia resulting from severe circulatory and renal dysfunction and which different papers have linked to a higher mortality rate. The main purpose of the present study is to determine if hyponatremia is an independent prognosis factor in the mortality of cirrhotic patients. MATERIAL AND METHODS: A retrospective study of cases and controls was carried out. Cirrhotic patients hospitalized in the Guillermo Almenara Irigoyen Hospital from January 2003 to June 2005 were evaluated; the patients who died with MELD10 were defined as cirrhotic; the controls were living cirrhotic patients with MELD
Asunto(s)
Hiponatremia/etiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Estudios de Casos y Controles , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Introducción: En la cirrosis hepática descompensada es conocido el desarrollo de complicaciones como hemorragia digestiva, encefalopatía, ascitis, peritonitis bacteriana espontánea. Otra alteración importante es el desarrollo de hiponatremia dilucional como resultado de una disfunción circulatoria y renal severa y que en diferentes trabajos se ha asociado a mayor mortalidad. El presente estudio tiene como objetivo fundamental determinar si la hiponatremia es un factor pronóstico independiente de mortalidad en los cirróticos. Material y métodos: Se realizó un estudio retrospectivo de casos y controles. Se evaluó a pacientes cirróticos internados en el Hospital Guillermo Almenara Irigoyen desde enero del 2003 hasta junio del 2005; los casos fueron definidos como cirróticos fallecidos con MELD (Modelo de Enfermedad Hepática Terminal) mayor o igual que 10; los controles fueron cirróticos vivos con MELD mayor o igual que 10; adicionalmente se les clasificó de acuerdo a la presencia o no de hiponatremia. Para cada grupo se determinó las características clínicas, analíticas, el grado de disfunción hepática y sodio sérico. Para la comparación entre grupos se utilizó la prueba de t de student y para determinar si la hiponatremia fue un factor pronóstico independiente de mortalidad se calculó el OR crudo y el ajustado, este último a través de un modelo de regresión logística. Resultados: Se contó con 40 casos y 56 controles. Se encontró hiponatremia en el 28.13 por ciento del total de cirróticos y en el 50 por ciento de los cirróticos que fallecieron. Al comparar los grupos de cirróticos vivos y fallecidos, se encontró diferencia significativa en la edad (p=0,013), Child (p=0,0001), MELD (p=0,004), bilirrubina (p=0,009), albúmina (p=0,0001), creatinina (p=0,019) y sodio sérico (p=0,002)...
Introduction: In the decompensated hepatic cirrhosis the development of complications such as bleeding in the digestive tracts, encephalopathy, ascites and spontaneous bacterial peritonitis is well-known; another important complication is the development of dilutional hyponatremia resulting from severe circulatory and renal dysfunction and which different papers have linked to a higher mortality rate. The main purpose of the present study is to determine if hyponatremia is an independent prognosis factor in the mortality of cirrhotic patients. Material and Methods: A retrospective study of cases and controls was carried out. Cirrhotic patients hospitalized in the Guillermo Almenara Irigoyen Hospital from January 2003 to June 2005 were evaluated; the patients who died with MELD10 were defined as cirrhotic; the controls were living cirrhotic patients with MELD menor o igual10. They further were classified according to the presence or not of hyponatremia. For each group the clinical and analytical characteristics, the extent of the hepatic dysfunction and the seric levels of sodium were established. In order to compare the groups the student t test was used; to determine if hyponatremia was an independent prognosis factor of mortality the raw OR and the adjusted OR were calculated, the latter through a model of logistic regression. Results: Forty (40) test patients and 56 controls were used. Hyponatremia was found in 28.13 per cent of the total of cirrhotic patients and in 50 per cent of the deceased cirrhotic patients. Upon comparing the groups of alive and deceased cirrhotic patients a significant difference was found in terms of the age (p=0.0013), Child (p=0.000), MELD (p=0.004), bilirrubin (p=0.009), albumin (p=0.000), creatinine (p=0.019) and seric sodium (p=0.002)...