Hyponatermia and Hypoalbuminemia as a Poor Prognostic Marker in Chronic Liver Disease Patients

Background: To study the hyponatermia and hypoalbuminemia as a poor prognostic marker in chronic liver disease patients Methods: Patients with chronic liver disease were recruited from medical wards after obtaining ethical clearance and written informed consent from the patient. Result: Serum albumin were lower among patients who died than survivors. Serum sodium were lower among patients who died than survivors. Serum potassium were higher among patients who died than survivors. Conclusion: We concluded that hyponatermia and hypoalbuminemia was a poor prognostic marker in chronic liver disease patients


Introduction
Chronic liver disease (CLD) is a progressive deterioration of liver functions for more than six months, which includes synthesis of clotting factors, other proteins, detoxification of harmful products of metabolism, and excretion of bile. CLD is a continuous process of inflammation, destruction, and regeneration of liver parenchyma, which leads to fibrosis and cirrhosis. The spectrum of etiologies is broad for chronic liver disease, which includes toxins, alcohol abuse for a prolonged time, infection, autoimmune diseases, genetic and metabolic disorders. Cirrhosis is a final stage of chronic liver disease that results in disruption of liver architecture, the formation of widespread nodules, vascular reorganization, neoangiogenesis, and deposition of an extracellular matrix. The underlying mechanism of fibrosis and cirrhosis at a cellular level is the recruitment of stellate cells and fibroblasts, resulting in fibrosis, while parenchymal regeneration relies on hepatic stem cells. Chronic liver disease is an extremely common clinical condition, and the focus is done on the common etiologies, clinical manifestations, and management. [1][2] Hyponatremia in advanced cirrhosis results from the hemodynamic complications associated with worsening portal hypertension, primarily intravascular hypovolemia and renal hypoperfusion in the setting of total body volume overload. Furthermore, the hepatic synthetic dysfunction associated with cirrhosis leads to abnormally low serum levels of albumin, a negatively charged protein that helps maintain adequate plasma oncotic pressure. Albumin Prem Kumar Arora et al.

International Journal of Medical and Biomedical Studies (IJMBS)
27 | P a g e therapy for intravascular volume expansion in cirrhosis was introduced as early as the 1950s, and has been shown in small studies to be superior to normal saline or fluid restriction for correcting serum sodium in cirrhotics. 3

Material and Methods
Patients with chronic liver disease were recruited from medical wards after obtaining ethical clearance and written informed consent from the patient.
Study Design: Observational longitudinal follow up study.

Selection of Subjects:
Inclusion Criteria:- • Patients of more than 18 years of age.
• Adult patients diagnosed with chronic liver disease.

Exclusion Criteria :-
• Patients with ascites due to tuberculosis or malignancy. • Patients with malignancies other than hepatocellular carcinoma.

Data analysis:
Interpretation and analysis with comparison of obtained results was carried out and data thus collected were subjected to descriptive statistical analysis of patients with chronic liver disease using SPSS 19, Student's T-test was used for comparison of continuous data. p-value <0.05 was considered significant. All repoted P values are two sided.

Results
Age range of patients was from 20 to 80 years. Mean age of patients was 48.94±12.63 years.
Male preponderance was seen in our series. Maximum number of patients of chronic liver disease were in the age group of 51 to 60 years.  Unpaired 't' Test Serum albumin were lower among patients who died than survivors. Serum sodium were lower among patients who died than survivors. Serum potassium were higher among patients who died than survivors.
Prem Kumar Arora et al.

International Journal of Medical and Biomedical Studies (IJMBS)
28 | P a g e

Discussion
As the liver cirrhosis progresses, there is fall in serum sodium concentration. It is a negative prognostic factor associated with increased shortterm mortality. 7 During cirrhosis, hyponatremia results from solute free water retention.
Volume expansion with resuscitative fluid infusion is often required for hospitalized cirrhotic patients. Evidence supports human serum albumin infusion in the treatment of certain specific complications of cirrhosis including HRS and prevention of both acute kidney injury in SBP and post-paracentesis circulatory dysfunction following large volume paracentesis. However, given the significantly higher cost associated with albumin compared to crystalloid, limiting administration to appropriate clinical indications is essential. 4 Albumin infusion is postulated to confer many benefits to cirrhotic patients beyond volume expansion, including immunomodulation, antioxidant effects, endothelial stabilization, and hemostatic effects, any and all of which might contribute to increased survival. 5

Conclusion
We concluded that hyponatermia and hypoalbuminemia was a poor prognostic marker in chronic liver disease patients