STUDY OF SERUM SODIUM LEVELS AND ITS CLINICAL SIGNIFICANCE IN DECOMPENSATED CHRONIC LIVER DISEASE PATIENTS ADMITTED IN A TERTIARY CARE CENTRE OF NORTH EASTERN STATE, TRIPURA

Introduction: Chronic Liver Disease is a major source of death and morbidity globally. Hyponatremia is one of the most common electrolyte abnormalities in chronic liver disease patients. Various studies have established a correlation between serum sodium levels and survival in these patients. Hyponatremia is a marker of severity in CLD patients and studies have shown its relationship with MELD score and Child Pugh score. The complications of DCLD and mortality also increases with hyponatremia. The aim of this study was to study the serum sodium levels in patients with DCLD and to establish its significance.

Materials And Methods: Data was collected from 100 patients admitted in medical wards. Patients were divided into 3 groups based on serum sodium levels and the relevant parameters analyzed among the groups. OBSERVATIONS: Among 100 patients, 45 had serum sodium levels ≥136 mEq/L, while 32 had serum sodium levels between 131 and 135 mEq/L and 23 patients had serum sodium level ≤130. No patients had serum sodium levels greater than 145. Serum sodium levels were associated strongly with the severity of liver disease as assessed by Child Pugh and MELD scores. Serum sodium ≤130 indicated the existence of Hepatic Encephalopathy, Hepatorenal Syndrome and Spontaneous Bacterial Peritonitis. Patients with serum sodium less than 130 mEq/L had increased frequency of complications than those with ≥136 mEq/L. Patient with serum sodium levels ≤130 had increased mortality.

Conclusion: Hyponatremia is more common in DCLD and low serum sodium levels are associated with increased frequency of complications such as hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis and GI bleeding. Lower serum sodium levels were associated with increased MELD and Child Pugh score and mortality indicating the inverse relationship between serum sodium levels and severity of the disease.

引言：慢性肝病（Chronic Liver Disease, CLD）是全球范围内致死与致病的主要病因之一。低钠血症（Hyponatremia）是慢性肝病患者最常见的电解质紊乱类型之一。多项研究已证实，此类患者的血清钠水平与生存率存在显著相关性。低钠血症是CLD患者病情严重程度的标志物，已有研究表明其与终末期肝病模型评分（MELD score）及Child-Pugh评分存在关联。低钠血症会增加失代偿性慢性肝病（Decompensated Chronic Liver Disease, DCLD）患者的并发症发生率与死亡率。本研究旨在探讨DCLD患者的血清钠水平，并明确其临床意义。

材料与方法：本研究纳入100名内科病房收治的患者，根据血清钠水平将其分为3组，并对各组的相关参数进行分析。
观察结果：100例患者中，45例血清钠水平≥136毫当量每升（mEq/L），32例血清钠水平介于131~135 mEq/L之间，23例血清钠水平≤130 mEq/L，无患者血清钠水平＞145 mEq/L。血清钠水平与通过Child-Pugh评分及MELD评分评估的肝病严重程度显著相关。血清钠≤130 mEq/L的患者更易出现肝性脑病（Hepatic Encephalopathy）、肝肾综合征（Hepatorenal Syndrome）及自发性细菌性腹膜炎（Spontaneous Bacterial Peritonitis）。血清钠＜130 mEq/L的患者，其并发症发生率显著高于血清钠≥136 mEq/L的患者；血清钠≤130 mEq/L的患者死亡率更高。

结论：低钠血症在DCLD患者中更为常见，血清钠水平降低与肝性脑病、肝肾综合征、自发性细菌性腹膜炎及胃肠道出血（Gastrointestinal bleeding, GI bleeding）等并发症发生率升高显著相关。血清钠水平越低，患者的MELD评分、Child-Pugh评分及死亡率越高，提示血清钠水平与肝病严重程度呈负相关。