title: Serum sodium and hydration status predict transplant-free survival independent of MELD score in patients with cirrhosis.
abstract: OBJECTIVE
  Serum sodium may have prognostic value in addition to the model for end-stage liver disease (MELD) score for prediction of early mortality in patients listed for liver transplant. In patients with cirrhosis, over-hydration is a common feature but its prognostic value has not been evaluated. This study examines the independent prognostic significance of MELD, serum sodium and hydration status on long-term survival in patients with cirrhosis.
  
  
  METHODS
  Serum sodium and hydration (total body water as a percentage of fat-free mass) were measured in 227 consecutive cirrhotic patients (146 male, 81 female; median age 49 years, range 19-73 years; median MELD score 13, range 6-36). Patients with hepatocellular carcinoma or listed for liver transplantation at the time of initial assessment were excluded. A competing risks Cox proportional hazards analysis was performed to evaluate the influence of MELD, sodium and hydration on risk of death or transplant.
  
  
  RESULTS
  Median follow-up was 52 (range 4-93) months. Serum sodium and hydration were each associated with reduction in time to death or transplant on univariate analysis (sodium: hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.87-0.94, P < 0.0001; hydration: HR 1.20, 95% CI 1.10-1.30, P < 0.0001). On multivariate analysis, MELD, serum sodium and hydration were independently predictive of death or transplant (MELD: HR 1.12, 95% CI 1.06-1.19, P < 0.0001; sodium: HR 0.93, 95% CI 0.87-0.99, P = 0.04; hydration: HR 1.17, 95% CI 1.02-1.33, P = 0.02).
  
  
  CONCLUSIONS
  In non-waitlisted patients with cirrhosis, serum sodium is predictive of transplant or death independent of MELD score.
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Sachin
authors.initials: S
authors.lastname: Mathur
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Gane
authors.forename: John L
authors.initials: JL
authors.lastname: McCall
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Plank
mesh_terms: D000328:Adult; D000368:Aged; D001834:Body Water / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*; D016019:Survival Analysis
chemical_list: D012964:Sodium