Hyponatremia increases mortality in pediatric patients listed for liver transplantation

Pediatr Transplant. 2010 Feb;14(1):115-20. doi: 10.1111/j.1399-3046.2009.01142.x. Epub 2009 Feb 22.

Abstract

To evaluate hyponatremia as an independent predictor of mortality in pediatric patients with end-stage liver disease listed for transplantation. We performed a single-center retrospective study of children listed for liver transplantation. We defined hyponatremia as a serum sodium concentration <130 mEq/L that persisted for at least seven days. The primary outcome was death on the waiting list. Ninety-four patients were eligible for the study. The prevalence of hyponatremia was 26%. Kaplan-Meier survival analysis demonstrated that patients with hyponatremia had decreased pretransplant survival compared with patients who maintained a serum sodium >130 mEq/L (p < 0.001). Univariable association analyses demonstrated death on the waiting list was also associated with higher median PELD scores at listing (p = 0.01), non-white race (p = 0.02), and age <1 yr (p = 0.001). Logistic regression analysis identified hyponatremia and non-white race as independently associated with pretransplant mortality [OR = 8.0 (95% CI: 1.4-45.7), p = 0.02 and OR = 6.3 (95% CI: 1.25-33.3), p = 0.03]. When hyponatremia was added to the PELD score, it was significantly better in predicting mortality than the PELD score alone (c-statistic = 0.79, p = 0.03). Hyponatremia identifies a subset of pediatric patients with increased risk of pretransplant mortality and improves the predictive ability of the current PELD score.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Hyponatremia / mortality*
  • Infant
  • Liver Failure / blood
  • Liver Failure / mortality*
  • Liver Failure / surgery
  • Liver Transplantation*
  • Male
  • Preoperative Period
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends
  • United States
  • Waiting Lists*