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Risk factors for hepatic encephalopathy in patients with cirrhosis and refractory ascites: relevance of serum sodium concentration

Authors

  • Mónica Guevara,

    1. Liver Unit Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
    2. Institut d′Investigacions Biomèdiques August Pi-Sunyer, Barcelona (IDIBAPS), Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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    • *Contributed equally.

  • María E. Baccaro,

    1. Liver Unit Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
    2. Institut d′Investigacions Biomèdiques August Pi-Sunyer, Barcelona (IDIBAPS), Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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    • *Contributed equally.

  • Jose Ríos,

    1. Statistics and Methodology Support Unit (Hospital Clinic), Barcelona, Spain
    2. Laboratory of Biostatistics & Epidemiology, Universitat Autonoma de Barcelona, Barcelona, Spain
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  • Marta Martín-Llahí,

    1. Liver Unit Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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  • Juan Uriz,

    1. Liver Unit Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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  • Luis Ruiz del Arbol,

    1. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
    2. Gastroenterology Unit, Hospital Ramón y Cajal, Madrid, Spain
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  • Ramón Planas,

    1. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
    2. Gastroenterology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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  • Alberto Monescillo,

    1. Hospital Insular de Gran Canaria, Islas Canarias, Spain
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  • Carlos Guarner,

    1. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
    2. Liver Unit, Hospital de Sant Pau, Barcelona, Spain
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  • Javier Crespo,

    1. Hospital Marqués de Valdecilla, Santander, Spain
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  • Rafael Bañares,

    1. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
    2. Hospital Puerta de Hierro, Madrid, Spain
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  • Vicente Arroyo,

    1. Liver Unit Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
    2. Institut d′Investigacions Biomèdiques August Pi-Sunyer, Barcelona (IDIBAPS), Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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  • Pere Ginès

    1. Liver Unit Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
    2. Institut d′Investigacions Biomèdiques August Pi-Sunyer, Barcelona (IDIBAPS), Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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Correspondence
Mónica Guevara, MD, PhD, Liver Unit. IDIBAPS, Hospital Clínic. Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
Tel: 349 3227 1713
Fax: 429 3451 5522
e-mail: mguevara@clinic.ub.es

Abstract

Hyponatraemia is common in patients with advanced cirrhosis and is associated with remarkable changes in brain cells, particularly a reduction in myoinositol and other intracellular organic osmolytes related to the hypo-osmolality of the extracellular fluid. It has been recently suggested that hyponatraemia may be an important factor associated with the development of overt hepatic encephalopathy (HE). To test this hypothesis, we retrospectively analysed the incidence and predictive factors of overt HE using a database of 70 patients with cirrhosis included in a prospective study comparing transjugular intrahepatic portosystemic shunts (TIPS) vs large-volume paracentesis in the management of refractory of ascites. Variables used in the analysis included age, sex, previous history of HE, treatment assignment (TIPS vs large volume paracentesis plus albumin), treatment with diuretics, serum bilirubin, serum creatinine and serum sodium concentration. Laboratory parameters were measured at entry, at 1 month and every 3 months during follow-up and at the time of development of HE in patients who developed this complication. During a mean follow-up of 10 months, 50 patients (71%) developed 117 episodes of HE. In the whole population of patients, the occurrence of HE was independently associated with serum hyponatraemia, serum bilirubin and serum creatinine. In conclusion, in patients with refractory ascites, the occurrence of HE is related to the impairment of liver and renal function and presence of hyponatraemia.

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