title: Hyponatremia in hepatocellular carcinoma complicating with cirrhosis.
abstract: OBJECTIVE
  We aimed to investigate the effect of serum sodium level on survival in hepatocellular carcinoma (HCC) patients complicating with liver cirrhosis (LC).
  
  
  METHODS
  A total of 1170 HCC patients with LC were analysed. We classified these patients into three groups according to serum sodium level at HCC diagnosis: group A (n=96); serum sodium ≤135 mmol/L, group B (n=520); 135 mmol/L < serum sodium ≤140 mmol/L, group C (n=554); serum sodium >140 mmol/L. We compared the baseline characteristics and overall survival (OS) among these three groups. Furthermore, we examined the factors linked to OS using univariate and multivariate analyses.
  
  
  RESULTS
  In our results, decreased baseline serum sodium level was significantly associated with Child-Pugh classification and HCC stage along with several laboratory parameters in groups A, B and C. The median follow-up period was 1.1 years in group A, 2.4 years in group B and 3.3 years in group C. The 1-, 3- and 5-year cumulative OS rates in groups A, B and C were 64.8%, 46.9% and 25.7%, respectively, in group A, 85.5%, 60.5% and 41.1%, respectively, in group B and 90.7%, 66.6% and 48.2%, respectively, in group C (P<0.001). The multivariate analyses showed that Child-Pugh classification (P<0.001), HCC stage (P<0.001), serum sodium (P<0.001), aspartate aminotransferase ≥57 IU/L (P=0.002), alkaline phosphatase ≥348 IU/L (P<0.001), alpha-fetoprotein ≥29.2 ng/mL (P=0.019) and des-γ-carboxy prothrombin ≥55 mAU/mL (P<0.001) were significant independent predictors linked to OS.
  
  
  CONCLUSIONS
  Lower serum sodium concentration is a useful predictor in HCC patients complicating with LC.
authors: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Hiroki
authors: H
authors: Nishikawa
authors: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Ryuichi
authors: R
authors: Kita
authors: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Toru
authors: T
authors: Kimura
authors: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Yoshiaki
authors: Y
authors: Ohara
authors: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Azusa
authors: A
authors: Sakamoto
authors: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Sumio
authors: S
authors: Saito
authors: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Norihiro
authors: N
authors: Nishijima
authors: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Akihiro
authors: A
authors: Nasu
authors: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Hideyuki
authors: H
authors: Komekado
authors: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Yukio
authors: Y
authors: Osaki
keywords: Hepatocellular carcinoma; Liver cirrhosis; Prognosis; Serum sodium