Differential impact of hyponatremia and hepatic encephalopathy on health-related quality of life and brain metabolite abnormalities in cirrhosis

被引：50

作者：

Ahluwalia, Vishwadeep ^{[1
,2
]}

Wade, James B. ^{[1
,2
]}

Thacker, Leroy ^{[1
,2
]}

Kraft, Kenneth A. ^{[1
,2
]}

Sterling, Richard K. ^{[1
,2
]}

Stravitz, R. Todd ^{[1
,2
]}

Fuchs, Michael ^{[1
,2
]}

Bouneva, Iliana ^{[1
,2
]}

Puri, Puneet ^{[1
,2
]}

Luketic, Velimir ^{[1
,2
]}

Sanyal, Arun J. ^{[1
,2
]}

Gilles, HoChong ^{[1
,2
]}

Heuman, Douglas M. ^{[1
,2
]}

Bajaj, Jasmohan S. ^{[1
,2
]}

机构：

[1] Virginia Commonwealth Univ, Richmond, VA 23249 USA

[2] McGuire VA Med Ctr, Richmond, VA 23249 USA

来源：

JOURNAL OF HEPATOLOGY | 2013年 / 59卷 / 03期

关键词：

Magnetic resonance spectroscopy; Hyponatremia; Hepatic encephalopathy; Cognitive function; Sickness Impact Profile; ORGANIC OSMOLYTES; SPECTROSCOPY; DIAGNOSIS; INSIGHT; RISK;

D O I：

10.1016/j.jhep.2013.04.023

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

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. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.

引用

页码：467 / 473

页数：7

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