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Published on: August 1, 2025
Hyponatremia: a significant factor in a poor prognosis for cirrhosis with Child A/B after variceal eradication
Hitoshi Maruyama1, Takayuki Kondo1, Tadashi Sekimoto1
1Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Insights
Pre-treatment hyponatremia is a significant prognostic factor for cirrhosis patients with esophageal varices treated with endoscopic sclerotherapy. Low serum sodium levels indicate a poorer prognosis and reduced survival rates.
Area of Science:
- Hepatology
- Gastroenterology
- Clinical Prognostics
Background:
- Cirrhosis management requires identifying prognostic factors post-esophageal varices (EV) eradication.
- Endoscopic sclerotherapy is a common treatment for EV.
Purpose of the Study:
- To prospectively identify prognostic factors in cirrhosis patients after EV eradication.
- To evaluate the impact of pre-treatment factors on patient outcomes.
Main Methods:
- A cohort of 52 cirrhosis patients (Child-Pugh A/B) underwent EV eradication via endoscopic sclerotherapy.
- Patients were observed for a median of 25.5 months post-treatment.
Main Results:
- Serum sodium concentration was the sole significant prognostic factor identified via multivariate analysis (HR 0.711, P = 0.0022).
- Patients with pre-treatment hyponatremia (<135 mEq/l) exhibited significantly lower survival rates at 1 and 3 years compared to those without.
Conclusions:
- Pre-treatment hyponatremia is a critical prognostic indicator in cirrhosis patients with Child A/B stages following EV eradication.
- Early identification and management of hyponatremia may improve outcomes for these patients.
Background:
To identify prognostic factors prospectively in cirrhosis after the eradication of esophageal varices (EV).
Methods:
There were 52 cirrhosis patients (Child-Pugh A 24, B 28) who showed the eradication of EV after the endoscopic sclerotherapy (median observation period, 25.5 months).
Results:
Eighteen patients showed a recurrence of EV. The cumulative overall survival rate was 92.2% at 1 year, 70.9% at 3 years, and 47.2% at 5 years. Univariate analysis showed that serum sodium concentration (hazard ratio [HR] 0.724, P = 0.0006), serum aspartate transaminase (HR 1.019, P = 0.0075), serum alanine transaminase (HR 1.025, P = 0.0239), and serum creatinine (HR 11.311, P = 0.044) levels before treatment were significant factors for a poor prognosis. Multivariate analysis revealed that serum sodium concentration (HR 0.711, P = 0.0022) was the only significant factor. The cumulative survival rate was lower in patients with hyponatremia (<135 mEq/l, a best cut-off value; 83.3% at 1 year, and 33.3% at 3 years), than in those without (93.3% at 1 year, 77.3% at 3 years and 47.2% at 5 years).
Conclusions:
Pre-treatment hyponatremia is a significant prognostic factor in cirrhosis with Child A/B after the eradication of EV by the endoscopic sclerotherapy.
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