title: Ascites and serum sodium are markers of increased waiting list mortality in children with chronic liver failure.
abstract: Ascites is the most common complication of cirrhosis and in adults it is associated with 50% mortality at 5 years if patients do not receive a liver transplant. The occurrence of hyponatremia in these patients has been associated with increased mortality on the waiting list. The importance of serum sodium levels and the presence of ascites in the pediatric setting remain to be clarified. A retrospective analysis of pediatric patients with cirrhosis on the transplant list was carried out between October 2000 and February 2012. The primary objective of this study was to evaluate the association of pretransplant variables with mortality within 90 days following the inclusion of patients on the waiting list. In all, 522 patients were included in the study; 345 (66%) patients were under 1 year of age; 208 (40%) of the children presented ascites. A multivariate Cox proportional hazards analysis was conducted and total bilirubin (P < 0.001, hazard ratio [HR] = 2.09, 95% confidence interval [CI] = 1.35-3.21), international normalized ratio (INR) (P < 0.001, HR = 9.83, 95% CI = 4.51-21.45), serum sodium levels (P = 0.03, HR = 0.96, 95% CI = 0.92-0.99), ascites (P = 0.001, HR = 2.59, 95% CI = 1.44-4.64), and categorized age (0-1 versus ≥ 1 year old) (P = 0.025, HR = 2.33, 95% CI = 1.11-4.86) were independently associated with risk of death in 90 days. Malnutrition (Z score height/age, weight/age) and serum albumin (pediatric endstage liver disease [PELD] formula) were not included in the final model.
  
  
  CONCLUSIONS
  The presence of ascites and serum sodium levels are important variables associated with decreased patient survival while candidates wait for a liver graft. Multicenter studies are necessary to validate these findings in order to improve current allocation policies based on the PELD score.
authors.affiliation: Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital; Hepatology and Liver Transplantation, AC Camargo Hospital.
authors.forename: Renata
authors.initials: R
authors.lastname: Pugliese
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Fonseca
authors.forename: Gilda
authors.initials: G
authors.lastname: Porta
authors.forename: Vera
authors.initials: V
authors.lastname: Danesi
authors.forename: Teresa
authors.initials: T
authors.lastname: Guimaraes
authors.forename: Adriana
authors.initials: A
authors.lastname: Porta
authors.forename: Irene K
authors.initials: IK
authors.lastname: Miura
authors.forename: Cristian
authors.initials: C
authors.lastname: Borges
authors.forename: Helry
authors.initials: H
authors.lastname: Candido
authors.forename: Marcel
authors.initials: M
authors.lastname: Benavides
authors.forename: Flavia H
authors.initials: FH
authors.lastname: Feier
authors.forename: Andre
authors.initials: A
authors.lastname: Godoy
authors.forename: Rita Antonelli
authors.initials: RA
authors.lastname: Cardoso
authors.forename: Mario
authors.initials: M
authors.lastname: Kondo
authors.forename: Paulo
authors.initials: P
authors.lastname: Chapchap
authors.forename: Joao Seda
authors.initials: JS
authors.lastname: Neto
mesh_terms: D000293:Adolescent; D001201:Ascites / Q000209:etiology / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood*; D014850:Waiting Lists
chemical_list: D015415:Biomarkers; D012964:Sodium