TY - JOUR
T1 - The Impact of Albumin Use on Resolution of Hyponatremia in Hospitalized Patients With Cirrhosis
AU - Bajaj, Jasmohan S.
AU - Tandon, Puneeta
AU - O’Leary, Jacqueline G.
AU - Biggins, Scott W.
AU - Wong, Florence
AU - Kamath, Patrick S.
AU - Garcia-Tsao, Guadalupe
AU - Maliakkal, Benedict
AU - Lai, Jennifer C.
AU - Fallon, Michael
AU - Thuluvath, Paul
AU - Vargas, Hugo E.
AU - Subramanian, Ram M.
AU - Thacker, Leroy R.
AU - Reddy, K. Rajender
N1 - Funding Information:
Guarantor of the article: JSB is the guarantor of the article. Specific author contributions: All authors enrolled patients and were responsible for drafting and editing the manuscript. LRT was involved in the statistical analysis. Financial Support: The NACSELD registry was supported by an investigator-initiated grant from Grifols Pharmaceuticals. Potential competing interests: JSB, FW, GGT, SWB, JO, KRR, and PT are consultants for Grifols Pharmaceuticals. The remaining authors declare that they have no conflict of interest.
Publisher Copyright:
© 2018, American College of Gastroenterology.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Objectives: Hyponatremia is associated with poor outcomes in cirrhosis independent of MELD. While intravenous albumin has been used in small series, its role in hyponatremia is unclear. The aim of this study is to determine the effect of albumin therapy on hyponatremia. Methods: Hospitalized cirrhotic patients included in the NACSELD (North American Consortium for End-Stage Liver Disease) cohort with hyponatremia (Na <130mmol/L) were divided into those receiving intravenous albumin or not. Determinants of hyponatremia resolution (Na ≥135 meq/L) and 30-day survival were analyzed using regression and ANCOVA models. Results: Overall, 2435 patients, of whom 1126 had admission hyponatremia, were included. Of these, 777 received 225 (IQR 100,400) g of albumin, while 349 did not. Patients given albumin had a higher admission MELD score, and serum creatinine and lower admission Na and mean arterial pressure (MAP). However they experienced a higher maximum Na and hyponatremia resolution (69% vs 61%, p = 0.008) compared to those who did not. On regression, delta Na was independently associated with admission creatinine, MAP and albumin use. On ANCOVA with logistic regression, there was a significant difference in hyponatremia resolution between those who did or did not receive albumin, even after adjustment for admission Na and GFR (85.41% vs 44.78%, p = 0.0057, OR: 1.50 95% CI: 1.13–2.00). Independent predictors of 30-day survival were hyponatremia resolution, age, ACLF, and admission GFR. Conclusion: Hospitalized patients with cirrhosis and hyponatremia who received intravenous albumin had a higher rate of hyponatremia resolution independent of renal function and baseline sodium levels, which was in turn associated with a better 30-day survival.
AB - Objectives: Hyponatremia is associated with poor outcomes in cirrhosis independent of MELD. While intravenous albumin has been used in small series, its role in hyponatremia is unclear. The aim of this study is to determine the effect of albumin therapy on hyponatremia. Methods: Hospitalized cirrhotic patients included in the NACSELD (North American Consortium for End-Stage Liver Disease) cohort with hyponatremia (Na <130mmol/L) were divided into those receiving intravenous albumin or not. Determinants of hyponatremia resolution (Na ≥135 meq/L) and 30-day survival were analyzed using regression and ANCOVA models. Results: Overall, 2435 patients, of whom 1126 had admission hyponatremia, were included. Of these, 777 received 225 (IQR 100,400) g of albumin, while 349 did not. Patients given albumin had a higher admission MELD score, and serum creatinine and lower admission Na and mean arterial pressure (MAP). However they experienced a higher maximum Na and hyponatremia resolution (69% vs 61%, p = 0.008) compared to those who did not. On regression, delta Na was independently associated with admission creatinine, MAP and albumin use. On ANCOVA with logistic regression, there was a significant difference in hyponatremia resolution between those who did or did not receive albumin, even after adjustment for admission Na and GFR (85.41% vs 44.78%, p = 0.0057, OR: 1.50 95% CI: 1.13–2.00). Independent predictors of 30-day survival were hyponatremia resolution, age, ACLF, and admission GFR. Conclusion: Hospitalized patients with cirrhosis and hyponatremia who received intravenous albumin had a higher rate of hyponatremia resolution independent of renal function and baseline sodium levels, which was in turn associated with a better 30-day survival.
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U2 - 10.1038/s41395-018-0119-3
DO - 10.1038/s41395-018-0119-3
M3 - Article
C2 - 29880972
AN - SCOPUS:85048130444
SN - 0002-9270
VL - 113
SP - 1339
EP - 1344
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 9
ER -