title: Hyponatremia increases mortality in pediatric patients listed for liver transplantation.
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.
authors.affiliation: Department of Pediatrics, Maine Medical Center, Portland, ME, USA. careyr3@mmc.org
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Carey
authors.forename: John C
authors.initials: JC
authors.lastname: Bucuvalas
authors.forename: William F
authors.initials: WF
authors.lastname: Balistreri
authors.forename: Todd G
authors.initials: TG
authors.lastname: Nick
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Ryckman
authors.forename: Nada
authors.initials: N
authors.lastname: Yazigi
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007010:Hyponatremia / Q000401:mortality*; D007223:Infant; D017093:Liver Failure / Q000097:blood / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States; D014850:Waiting Lists