title: Rapid correction rate of hyponatremia as an independent risk factor for neurological complication following liver transplantation.
abstract: Hyponatremia is prevalent before liver transplantation and generally corrected immediately after transplantation.  However, the clinical significance of correction rate of hyponatremia is not well investigated.  The prognostic impact of pre-transplant serum sodium concentrations and post-transplant correction rate of hyponatremia were assessed.  A total of 512 patients who received orthotopic liver transplants were enrolled.  The correction rate of hyponatremia (delta sodium, ΔNa) was calculated based on the data collected during the first 48 hours following liver transplantation.  Outcomes, including in-hospital mortality, delirium, neurological complications, acute kidney injury, and infections, were compared according to the serum sodium levels (sNa < 125, 125-135, and ≥ 135 mmol/L), and the risk factors for in-hospital mortality and neurological complications were analyzed using multivariate logistic regression methods.  Patients with severe hyponatremia (sNa < 125 mmol/L) had higher rates of in-hospital mortality (9.6%, P = 0.010), delirium (54.8%, P = 0.003), neurological complications (24.7%, P = 0.003), and acute kidney injury (57.5%, P = 0.005).  In multivariate analysis, serum sodium levels (OR = 0.975, P = 0.402) and delta sodium (OR = 1.097, P = 0.066) were not independent risk factors for in-hospital mortality.  However, delta sodium (OR = 1.093, P = 0.003) and fast correction rate of hyponatremia (ΔNa ≥ 12 mmol/L/24h, OR = 3.397, P = 0.023) were significantly associated with post-transplant neurological complications.  Pre-transplantation hyponatremia was not independently associated with clinical outcomes.  However, rapid correction of hyponatremia is an independent risk factor for the development of post-transplant neurological complications.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jeonghwan
authors.initials: J
authors.lastname: Lee
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Kook-Hwan
authors.initials: KH
authors.lastname: Oh
authors.forename: Yun Kyu
authors.initials: YK
authors.lastname: Oh
authors.forename: Ki Young
authors.initials: KY
authors.lastname: Na
authors.forename: Yon Su
authors.initials: YS
authors.lastname: Kim
authors.forename: Jin Suk
authors.initials: JS
authors.lastname: Han
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Kwon Wook
authors.initials: KW
authors.lastname: Joo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000503:physiopathology; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002493:Central Nervous System Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003711:Demyelinating Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007010:Hyponatremia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007177:Inappropriate ADH Syndrome / Q000628:therapy; D008103:Liver Cirrhosis / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012964:Sodium / Q000097:blood; D015996:Survival Rate; D055815:Young Adult
chemical_list: D012964:Sodium