Incidence and Associated factors to development of hyponatremia in a cohort of ambulatory patients with compensated liver cirrhosis
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Talavera, Nayeli Ortiz-Olvera, Rosalba Moreno Alcántar, Segundo Moran Villota" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Marlene" "apellidos" => "López-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0001" ] ] ] 1 => array:3 [ "nombre" => "Juan O." "apellidos" => "Talavera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0002" ] ] ] 2 => array:3 [ "nombre" => "Nayeli" "apellidos" => "Ortiz-Olvera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0003" ] ] ] 3 => array:3 [ "nombre" => "Rosalba Moreno" "apellidos" => "Alcántar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0003" ] ] ] 4 => array:3 [ "nombre" => "Segundo Moran" "apellidos" => "Villota" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0001" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Laboratorio de Investigación en Gastro-Hepatología, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México" "etiqueta" => "1" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Dirección de Enseñanza e Investigación, Centro Médico ABC, Ciudad de México" "etiqueta" => "2" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Servicio de Gastroenterología, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México" "etiqueta" => "3" "identificador" => "aff0003" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Ethical statement</span></p><p id="para0006" class="elsevierStylePara elsevierViewall">The protocol was registered and approved by the Ethics Committee. The identity of the patients is protected. Consentment was obtained.</p><p id="para0007" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Declaration of interests</span></p><p id="para0008" class="elsevierStylePara elsevierViewall">None</p><p id="para0009" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Funding</span></p><p id="para0010" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p><p id="para0011" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="utbl0001"></elsevierMultimedia></p><p id="para0012" class="elsevierStylePara elsevierViewall">∗ Fisher exact test.</p><p id="para0013" class="elsevierStylePara elsevierViewall">Unadjusted risk: RH-MELD I (reference), II (RR:3.67, CI 95%:0.71-19.01, p=0.121), III (RR:11.53, CI 95%: 2.01-66.13, p=0.006).</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0001">Introduction and Objectives</span><p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Hyponatremia is associated with ascites, hepatic encephalopathy, primary bacterial peritonitis, and increased mortality. However, the information about incidence and factors associated with hyponatremia in ambulatory patients with compensated cirrhosis is scarce. The aim of the study was to estimate the incidence and associated factors to the development of hypervolemic hyponatremia.</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Materials and Patients</span><p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Ambulatory patients with compensated cirrhosis seen at Medical Center Siglo XXI were selected. All variables included in Child-Pugh Index and in the MELD Score and the types of treatment diet were analyzed. Hyponatremia was considered when serum concentration of sodium was <135 mEq/L in hypotonic state and water retention.</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Results</span><p id="spara003" class="elsevierStyleSimplePara elsevierViewall">The incidence of hyponatremia was 9.6% (13/135). A prognostic risk index was identified based on fluid retention and the baseline MELD score (RH-MELD Index) (Table 1). A higher incidence of hyponatremia was observed in patients in category III [RR: 7.96 (95%CI: 1.17-54.06, p=0.034)], when adjusting for diet; patients with protein supplement consumption without a structured diet had a higher risk of hyponatremia [RR: 17.72 (95%CI: 3.50-89.52), p=0.001)].</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Conclusions</span><p id="spara004" class="elsevierStyleSimplePara elsevierViewall">The results suggest that the incidence of dilutional hyponatremia in outpatients with cirrhosis is frequent; mild alterations in water retention and liver function in the compensated phase represent an early indicator of its development, which can be modified by the indicated diet.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Introduction and Objectives" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Materials and Patients" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusions" ] ] ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "utbl0001" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><a name="en0001"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="3" align="center" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Risk categories for Hyponatremia</span></td></tr><tr title="table-row"><a name="en0002"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">(RH-MELD) Categories \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0003"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">N (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0004"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">P value \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0005"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">I: No water retention, MELD ≤9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2/62 (3.2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0007"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Reference \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0008"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">II: Water retention or MELD ≥10 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6/55 (10.9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.201 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">III: Water retention + MELD ≥10 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">5/18 (27.8) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0013"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.010* \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3519261.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara005a" class="elsevierStyleSimplePara elsevierViewall">RH-MELD Index.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/00000029000000S2/v2_202404250742/S1665268124001893/v2_202404250742/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/16652681/00000029000000S2/v2_202404250742/S1665268124001893/v2_202404250742/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268124001893?idApp=UINPBA00004N" ]
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