Hyponatremia as a prognostic indicator of mortality and complications in patients with cirrhosis: A Prospective Cross-Sectional Study

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Background: Hyponatremia frequently accompanies advanced cirrhosis and may reflect the severity of hepatic dysfunction and circulatory abnormalities. This study investigated whether serum sodium concentration was associated with disease severity, major complications, and in-hospital mortality among patients with cirrhosis. Methods: A prospective cross-sectional study was conducted at Al-Mouassat and National University Hospitals in Damascus, Syria, between March 2022 and March 2023. The study enrolled 160 adult patients with documented cirrhosis. Disease severity was evaluated using the Child-Pugh classification and Model for End-Stage Liver Disease (MELD) score. Hyponatremia was defined as a serum sodium concentration ≤130 mEq/L. Associations between hyponatremia and cirrhosis severity, complications, and in-hospital mortality were assessed using the chi-square test, Student's t-test, and odds ratio (OR) estimation. Results: Fifty-four patients (33.7%) had serum sodium concentrations ≤130 mEq/L. Hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome were more frequent in patients with hyponatremia than in those with higher sodium concentrations (p=0.027, p=0.023, and p=0.012, respectively). Patients with hyponatremia also had significantly higher mean MELD scores. Of the patients with hyponatremia, 49 (90.7%) were classified as Child-Pugh C. Hyponatremia was significantly associated with Child-Pugh C cirrhosis (OR 4.83; 95% CI 1.7–13.2; p=0.002). In addition, patients with hyponatremia had higher odds of in-hospital mortality (OR 2.46; 95% CI 1–6; p=0.048). Conclusions: Serum sodium ≤130 mEq/L was associated with greater severity of cirrhosis, as reflected by higher MELD and Child-Pugh scores, as well as an increased frequency of hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome. Hyponatremia was also associated with higher in-hospital mortality. These findings support the clinical value of serum sodium assessment as part of the evaluation of patients with cirrhosis.