- 作者：Vishwadeep Ahluwalia ; James B. Wade ; Leroy Thacker ; Kenneth A. Kraft ; Richard K. Sterling ; R. Todd Stravitz ; Michael Fuchs ; Iliana Bouneva ; Puneet Puri ; Velimir Luketic ; Arun J. Sanyal ; HoChong Gilles ; Douglas M. Heuman ; Jasmohan S. Bajaj
- 关键词：HRQOL ; health-related quality of life ; SIP ; sickness impact profile ; MRS ; magnetic resonance spectroscopy ; MRI ; magnetic resonance imaging ; HE ; hepatic encephalopathy ; HN ; hyponatremia ; N ; neither HE nor hyponatremia ; HE ; + ; HN ; hepatic encephalop
- 刊名：Journal of Hepatology
- 出版年：2013
- 出版时间：September, 2013
- 年：2013
- 卷：59
- 期：3
- 页码：467-473
- 全文大小：732 K
Background & Aims
Hyponatremia (HN) and hepatic encephalopathy (HE) together can impair health-related quality of life (HRQOL) and cognition in cirrhosis. We aimed at studying the effect of hyponatremia on cognition, HRQOL, and brain MR spectroscopy (MRS) independent of HE.Methods
Four cirrhotic groups (no HE/HN, HE alone, HN alone (sodium <130 mEq/L), HE + HN) underwent cognitive testing, HRQOL using Sickness Impact Profile (SIP: higher score is worse; has psychosocial and physical sub-scores) and brain MRS (myoinositol (mI) and glutamate + glutamine (Glx)), which were compared across groups. A subset underwent HRQOL testing before/after diuretic withdrawal.
Results
82 cirrhotics (30 no HE/HN, 25 HE, 17 HE + HN, and 10 HN, MELD 12, 63 % hepatitis C) were included. Cirrhotics with HN alone and without HE/HN had better cognition compared to HE groups (median abnormal tests no-HE/HN: 3, HN: 3.5, HE: 6.5, HE + HN: 7, p = 0.008). Despite better cognition, HN only patients had worse HRQOL in total and psychosocial SIP while both HN groups (with/without HE) had a significantly worse physical SIP (p <0.0001, all comparisons). Brain MRS showed the lowest Glx in HN and the highest in HE groups (p <0.02). mI levels were comparably decreased in the three affected (HE, HE + HN, and HN) groups compared to no HE/HN and were associated with poor HRQOL. Six HE + HN cirrhotics underwent diuretic withdrawal which improved serum sodium and total/psychosocial SIP scores.
Conclusions
Hyponatremic cirrhotics without HE have poor HRQOL despite better cognition than those with concomitant HE. Glx levels were lowest in HN without HE but mI was similar across affected groups. HRQOL improved after diuretic withdrawal. Hyponatremia has a complex, non-linear relationship with brain Glx and mI, cognition and HRQOL.