Hypervolemic hyponatremia and transplant-free survival in children with cirrhosis due to biliary atresia.

Autor: Silva Duarte Dos Santos R; Programa de Pós-Graduação Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Kieling CO; Unidade de Gastroenterologia e Hepatologia Pediátrica, Programa de Transplante Hepático Infantil, Hospital de Clínicas de Porto Alegre. Serviço de Pediatria, Porto Alegre, Brazil., Adami MR; Unidade de Gastroenterologia e Hepatologia Pediátrica, Programa de Transplante Hepático Infantil, Hospital de Clínicas de Porto Alegre. Serviço de Pediatria, Porto Alegre, Brazil., Guedes RR; Unidade de Gastroenterologia e Hepatologia Pediátrica, Programa de Transplante Hepático Infantil, Hospital de Clínicas de Porto Alegre. Serviço de Pediatria, Porto Alegre, Brazil., Vieira SMG; Programa de Pós-Graduação Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Unidade de Gastroenterologia e Hepatologia Pediátrica, Programa de Transplante Hepático Infantil, Hospital de Clínicas de Porto Alegre. Serviço de Pediatria, Porto Alegre, Brazil.; Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2020 May; Vol. 24 (3), pp. e13687. Date of Electronic Publication: 2020 Mar 05.
DOI: 10.1111/petr.13687
Abstrakt: Background: Biliary atresia is the number one cause of cirrhosis and liver transplantation in children. Hyponatremia is the most important electrolytic disturbance observed in decompensated cirrhosis. Studies of hyponatremia in cirrhotic children are scarce and those that exist have defined hyponatremia as serum sodium < 130 mEq/L lasting for at least 7 days.
Methods: We evaluated transplant-free survival (Kaplan-Meier) of children with cirrhosis due to biliary atresia and serum sodium < 130 mEq/L persisting for 1, 2-6, and ≥7 days. This was a single-center, historical cohort that included all patients aged ≤ 18 years on a liver transplantation waiting list.
Results: We studied 128 patients. The overall frequency of hyponatremia was 30.5% (39/128). Thirteen patients (10.2%) had hyponatremia when put on the list, and 20.3% developed it during follow-up. The Kaplan-Meier overall transplant-free survival rate was 83.3%. Patients with persistent hyponatremia for at least two days had the lowest transplant-free survival. Glomerular filtration rate (P = .00, RR = 0.96, IC 95% = 0.94-0.99), BMI/age Z-score (P = .02, RR = 0.59, IC 95% = 0.39-0.91), INR (P = .00, RR = 1.43, IC 95% = 1.17-1.74), and serum sodium (P = .04, RR = 0.91, IC 95% = 0.84-0.99) were independently associated with transplant-free survival. We did not observe any difference in mortality prediction after adding sodium to the original PELD score.
Conclusions: We conclude that persistent hyponatremia lasting at least two days may herald poor prognosis for children with cirrhosis due to biliary atresia.
(© 2020 Wiley Periodicals, Inc.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje