Hyponatremia Is Protective Against the Development of Portal Vein Thrombosis in Patients Undergoing Liver Transplant

Dmitri Bezinover, Seyedehsan Navabi, Ming Wang, Zheng Li, Meryl William, Jonathan Stine

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Both hyponatremia and portal vein thrombosis (PVT) reflect the severity of liver dysfunction and are independently associated with increased morbidity in cirrhotic patients. In this study, we analyzed effects of hyponatremia on PVT development. METHODS: Data on adult liver transplants (LTs) in the Model for End-Stage Liver Disease era through September 2016 were obtained. Receiver operating curves and multivariable logistic regression models were constructed to evaluate the association between serum sodium level and PVT. Based on the receiver operating curves, hyponatremia was defined as a sodium level below 125 mEq/L. RESULTS: Of the 49,155 recipients included, 16% had hyponatremia (n = 7828) and 9% had PVT (n = 4414) at transplant. Subjects with hyponatremia had lower rates of PVT at the time of LT (4.4% vs 10.1%, P < .001), incidence of nonalcoholic steatohepatitis (10.8% vs 16.5%, P < .001), diabetes (19.7% vs 24.3%, P < .001), and need for dialysis (8.8% vs 16.0%, P < .001) as well as higher rates of chronic hepatitis C and B (37.6% vs 29.1%, P < .001 and 2.9% vs 1.7%, P < .001). Multivariable regression analysis confirmed that hyponatremia was independently associated with a decreased likelihood of PVT (odds ratio [OR], 0.44, P < .001). African American patients had a lower incidence of PVT (OR, 0.70; P < .001). Variables associated with a higher incidence of PVT were: nonalcoholic steatohepatitis (OR, 1.15; P = .005), moderate-to-severe ascites (OR, 1.10; P = .008), and Hispanic ethnicity (OR, 1.2; P < .001). CONCLUSION: Hyponatremia is associated with a lower rate of PVT independent of severity of liver disease and other thrombotic risk factors. This protective effect should be taken into consideration during the perioperative management of hyponatremia in patients undergoing LT.

Original languageEnglish (US)
Pages (from-to)1880-1886
Number of pages7
JournalTransplantation proceedings
Volume51
Issue number6
DOIs
StatePublished - Jul 1 2019

Fingerprint

Hyponatremia
Portal Vein
Thrombosis
Transplants
Liver
Odds Ratio
Liver Diseases
Incidence
Logistic Models
Sodium
End Stage Liver Disease
Chronic Hepatitis B
Chronic Hepatitis C
Hispanic Americans
Ascites
African Americans
Dialysis
Regression Analysis
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

Cite this

@article{9a9b8b91156f497083baba633c0639ad,
title = "Hyponatremia Is Protective Against the Development of Portal Vein Thrombosis in Patients Undergoing Liver Transplant",
abstract = "BACKGROUND: Both hyponatremia and portal vein thrombosis (PVT) reflect the severity of liver dysfunction and are independently associated with increased morbidity in cirrhotic patients. In this study, we analyzed effects of hyponatremia on PVT development. METHODS: Data on adult liver transplants (LTs) in the Model for End-Stage Liver Disease era through September 2016 were obtained. Receiver operating curves and multivariable logistic regression models were constructed to evaluate the association between serum sodium level and PVT. Based on the receiver operating curves, hyponatremia was defined as a sodium level below 125 mEq/L. RESULTS: Of the 49,155 recipients included, 16{\%} had hyponatremia (n = 7828) and 9{\%} had PVT (n = 4414) at transplant. Subjects with hyponatremia had lower rates of PVT at the time of LT (4.4{\%} vs 10.1{\%}, P < .001), incidence of nonalcoholic steatohepatitis (10.8{\%} vs 16.5{\%}, P < .001), diabetes (19.7{\%} vs 24.3{\%}, P < .001), and need for dialysis (8.8{\%} vs 16.0{\%}, P < .001) as well as higher rates of chronic hepatitis C and B (37.6{\%} vs 29.1{\%}, P < .001 and 2.9{\%} vs 1.7{\%}, P < .001). Multivariable regression analysis confirmed that hyponatremia was independently associated with a decreased likelihood of PVT (odds ratio [OR], 0.44, P < .001). African American patients had a lower incidence of PVT (OR, 0.70; P < .001). Variables associated with a higher incidence of PVT were: nonalcoholic steatohepatitis (OR, 1.15; P = .005), moderate-to-severe ascites (OR, 1.10; P = .008), and Hispanic ethnicity (OR, 1.2; P < .001). CONCLUSION: Hyponatremia is associated with a lower rate of PVT independent of severity of liver disease and other thrombotic risk factors. This protective effect should be taken into consideration during the perioperative management of hyponatremia in patients undergoing LT.",
author = "Dmitri Bezinover and Seyedehsan Navabi and Ming Wang and Zheng Li and Meryl William and Jonathan Stine",
year = "2019",
month = "7",
day = "1",
doi = "10.1016/j.transproceed.2019.05.014",
language = "English (US)",
volume = "51",
pages = "1880--1886",
journal = "Transplantation Proceedings",
issn = "0041-1345",
publisher = "Elsevier USA",
number = "6",

}

Hyponatremia Is Protective Against the Development of Portal Vein Thrombosis in Patients Undergoing Liver Transplant. / Bezinover, Dmitri; Navabi, Seyedehsan; Wang, Ming; Li, Zheng; William, Meryl; Stine, Jonathan.

In: Transplantation proceedings, Vol. 51, No. 6, 01.07.2019, p. 1880-1886.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hyponatremia Is Protective Against the Development of Portal Vein Thrombosis in Patients Undergoing Liver Transplant

AU - Bezinover, Dmitri

AU - Navabi, Seyedehsan

AU - Wang, Ming

AU - Li, Zheng

AU - William, Meryl

AU - Stine, Jonathan

PY - 2019/7/1

Y1 - 2019/7/1

N2 - BACKGROUND: Both hyponatremia and portal vein thrombosis (PVT) reflect the severity of liver dysfunction and are independently associated with increased morbidity in cirrhotic patients. In this study, we analyzed effects of hyponatremia on PVT development. METHODS: Data on adult liver transplants (LTs) in the Model for End-Stage Liver Disease era through September 2016 were obtained. Receiver operating curves and multivariable logistic regression models were constructed to evaluate the association between serum sodium level and PVT. Based on the receiver operating curves, hyponatremia was defined as a sodium level below 125 mEq/L. RESULTS: Of the 49,155 recipients included, 16% had hyponatremia (n = 7828) and 9% had PVT (n = 4414) at transplant. Subjects with hyponatremia had lower rates of PVT at the time of LT (4.4% vs 10.1%, P < .001), incidence of nonalcoholic steatohepatitis (10.8% vs 16.5%, P < .001), diabetes (19.7% vs 24.3%, P < .001), and need for dialysis (8.8% vs 16.0%, P < .001) as well as higher rates of chronic hepatitis C and B (37.6% vs 29.1%, P < .001 and 2.9% vs 1.7%, P < .001). Multivariable regression analysis confirmed that hyponatremia was independently associated with a decreased likelihood of PVT (odds ratio [OR], 0.44, P < .001). African American patients had a lower incidence of PVT (OR, 0.70; P < .001). Variables associated with a higher incidence of PVT were: nonalcoholic steatohepatitis (OR, 1.15; P = .005), moderate-to-severe ascites (OR, 1.10; P = .008), and Hispanic ethnicity (OR, 1.2; P < .001). CONCLUSION: Hyponatremia is associated with a lower rate of PVT independent of severity of liver disease and other thrombotic risk factors. This protective effect should be taken into consideration during the perioperative management of hyponatremia in patients undergoing LT.

AB - BACKGROUND: Both hyponatremia and portal vein thrombosis (PVT) reflect the severity of liver dysfunction and are independently associated with increased morbidity in cirrhotic patients. In this study, we analyzed effects of hyponatremia on PVT development. METHODS: Data on adult liver transplants (LTs) in the Model for End-Stage Liver Disease era through September 2016 were obtained. Receiver operating curves and multivariable logistic regression models were constructed to evaluate the association between serum sodium level and PVT. Based on the receiver operating curves, hyponatremia was defined as a sodium level below 125 mEq/L. RESULTS: Of the 49,155 recipients included, 16% had hyponatremia (n = 7828) and 9% had PVT (n = 4414) at transplant. Subjects with hyponatremia had lower rates of PVT at the time of LT (4.4% vs 10.1%, P < .001), incidence of nonalcoholic steatohepatitis (10.8% vs 16.5%, P < .001), diabetes (19.7% vs 24.3%, P < .001), and need for dialysis (8.8% vs 16.0%, P < .001) as well as higher rates of chronic hepatitis C and B (37.6% vs 29.1%, P < .001 and 2.9% vs 1.7%, P < .001). Multivariable regression analysis confirmed that hyponatremia was independently associated with a decreased likelihood of PVT (odds ratio [OR], 0.44, P < .001). African American patients had a lower incidence of PVT (OR, 0.70; P < .001). Variables associated with a higher incidence of PVT were: nonalcoholic steatohepatitis (OR, 1.15; P = .005), moderate-to-severe ascites (OR, 1.10; P = .008), and Hispanic ethnicity (OR, 1.2; P < .001). CONCLUSION: Hyponatremia is associated with a lower rate of PVT independent of severity of liver disease and other thrombotic risk factors. This protective effect should be taken into consideration during the perioperative management of hyponatremia in patients undergoing LT.

UR - http://www.scopus.com/inward/record.url?scp=85071281443&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071281443&partnerID=8YFLogxK

U2 - 10.1016/j.transproceed.2019.05.014

DO - 10.1016/j.transproceed.2019.05.014

M3 - Article

VL - 51

SP - 1880

EP - 1886

JO - Transplantation Proceedings

JF - Transplantation Proceedings

SN - 0041-1345

IS - 6

ER -