Hyponatremia increases mortality in pediatric patients listed for liver transplantation
Article first published online: 22 FEB 2009
© 2009 John Wiley & Sons A/S
Volume 14, Issue 1, pages 115–120, February 2010
How to Cite
Carey, R. G., Bucuvalas, J. C., Balistreri, W. F., Nick, T. G., Ryckman, F. R. and Yazigi, N. (2010), Hyponatremia increases mortality in pediatric patients listed for liver transplantation. Pediatric Transplantation, 14: 115–120. doi: 10.1111/j.1399-3046.2009.01142.x
- Issue published online: 8 JAN 2010
- Article first published online: 22 FEB 2009
- Accepted for publication 5 January 2009
- end-stage liver disease;
- pediatric end-stage liver disease score;
- renal dysfunction;
- transplant morbidity
Carey RG, Bucuvalas JC, Balistreri WF, Nick TG, Ryckman FR, Yazigi N. Hyponatremia increases mortality in pediatric patients listed for liver transplantation. Pediatr Transplantation 2010: 14: 115–120. © 2009 John Wiley & Sons A/S.
Abstract: To evaluate hyponatremia as an independent predictor of mortality in pediatric patients with end-stage liver disease listed for transplantation. We performed a single-center retrospective study of children listed for liver transplantation. We defined hyponatremia as a serum sodium concentration <130 mEq/L that persisted for at least seven days. The primary outcome was death on the waiting list. Ninety-four patients were eligible for the study. The prevalence of hyponatremia was 26%. Kaplan–Meier survival analysis demonstrated that patients with hyponatremia had decreased pretransplant survival compared with patients who maintained a serum sodium >130 mEq/L (p < 0.001). Univariable association analyses demonstrated death on the waiting list was also associated with higher median PELD scores at listing (p = 0.01), non-white race (p = 0.02), and age <1 yr (p = 0.001). Logistic regression analysis identified hyponatremia and non-white race as independently associated with pretransplant mortality [OR = 8.0 (95% CI: 1.4–45.7), p = 0.02 and OR = 6.3 (95% CI: 1.25–33.3), p = 0.03]. When hyponatremia was added to the PELD score, it was significantly better in predicting mortality than the PELD score alone (c-statistic = 0.79, p = 0.03). Hyponatremia identifies a subset of pediatric patients with increased risk of pretransplant mortality and improves the predictive ability of the current PELD score.