ArticleCritical care (London, England)2014
Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study.
Article in Critical care (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.
- Risk factors for the mortality of hepatitis B virus-associated acute-on-chronic liver failure: a systematic review and meta-analysis.BMC gastroenterology · 2023Pooled it
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- Human albumin infusion for reducing hyponatremia and circulatory dysfunction in liver cirrhosis: A meta-analysis update.World journal of hepatology · 2025Article
- Development with external validation of a prediction model for postoperative acute kidney injury following noncardiac surgery in elderly patients.BMC geriatrics · 2025Article
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- New prognostic model for hospitalized patients with alcoholic cirrhosis and Maddrey's discriminant function <32.Hepatology international · 2024Article
- Letter regarding "Evidence-based hyponatremia management in liver disease".Clinical and molecular hepatology · 2023Article
- Evidence-based hyponatremia management in liver disease.Clinical and molecular hepatology · 2023Review
- Prevalence and clinical significance of serum sodium variability in patients with acute-on-chronic liver diseases: a prospective multicenter study in China.Hepatology international · 2022Article
- Comparative accuracy of prognostic models for short-term mortality in acute-on-chronic liver failure patients: CAP-ACLF.Hepatology international · 2021Article
- Hyponatremia is a potential predictor of progression in radiation-induced brain necrosis: a retrospective study.BMC neurology · 2018Article
- Observational
- Osmotic Shifts, Cerebral Edema, and Neurologic Deterioration in Severe Hepatic Encephalopathy.Critical care medicine · 2018Article
- Bacterial Infection and Predictors of Mortality in Patients with Autoimmune Liver Disease-Associated Acute-On-Chronic Liver Failure.Canadian journal of gastroenterology & hepatology · 2018Article
- Characteristics of infection and its impact on short-term outcome in patients with acute-on-chronic liver failure.Medicine · 2017Article
- Electrolyte and Acid-Base Disturbances in End-Stage Liver Disease: A Physiopathological Approach.Digestive diseases and sciences · 2017Review
- Treatment of Cirrhosis-Associated Hyponatremia with Midodrine and Octreotide.Frontiers in medicine · 2017Article
- Presumptive Iatrogenic Microcystin-Associated Liver Failure and Encephalopathy in a Holsteiner Gelding.Journal of veterinary internal medicine · 2016Article
- Hyponatremia in patients with liver diseases: not just a cirrhosis-induced hemodynamic compromise.Hepatology international · 2016Review
Corrections and comments
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Authors and funding
14 authors at 7 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionHyponatremia is a marker of poor prognosis in patients with cirrhosis. This analysis aimed to assess if hyponatremia also has prognostic value in patients with acute-on-chronic liver failure (ACLF), a syndrome characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality.
methodsWe performed an analysis of the Chronic Liver Failure Consortium CANONIC database in 1,341 consecutive patients admitted to 29 European centers with acute decompensation of cirrhosis (including ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infections, or any combination of these), both with and without associated ACLF (301 and 1,040 respectively).
resultsOf the 301 patients with ACLF, 24.3% had hyponatremia at inclusion compared to 12.3% of 1,040 patients without ACLF (P <0.001). Model for end-stage liver disease, Child-Pugh and chronic liver failure-SOFA scores were significantly higher in patients with ACLF and hyponatremia compared to those without hyponatremia. The presence of hyponatremia (at inclusion or during hospitalization) was a predictive factor of survival both in patients with and without ACLF. The presence of hyponatremia and ACLF was found to have an independent effect on 90-day survival after adjusting for the potential confounders. Hyponatremia in non-ACLF patients nearly doubled the risk (hazard ratio (HR) 1.81 (1.33 to 2.47)) of dying at 90 days. However, when considering patients with both factors (ACLF and hyponatremia) the relative risk of dying at 90 days was significantly higher (HR 6.85 (3.85 to 12.19) than for patients without both factors. Patients with hyponatremia and ACLF had a three-month transplant-free survival of only 35.8% compared to 58.7% in those with ACLF without hyponatremia (P <0.001).
conclusionsThe presence of hyponatremia is an independent predictive factor of survival in patients with ACLF. In cirrhosis, outcome of patients with ACLF is dependent on its association with hyponatremia.
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