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Improvement of hyponatremia in cirrhosis is associated with improved complex information processing
Author(s) -
Watson Hugh,
Guevara Monica,
Vilstrup Hendrik,
Ginès Pere
Publication year - 2019
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14683
Subject(s) - hyponatremia , medicine , cirrhosis , hepatic encephalopathy , ascites , placebo , gastroenterology , liver function , encephalopathy , pathology , alternative medicine
Background and Aim Hyponatremia, a cause of brain dysfunction and risk factor for hepatic encephalopathy, is frequent in patients with advanced cirrhosis and ascites. The interdependence of liver failure and hyponatremia makes it difficult to separate the effects of each on cognitive function. The objective was to assess whether an increase in plasma sodium in patients with cirrhosis and ascites leads to an improvement in cognitive function. Methods This is a post‐hoc analysis of 250 cirrhosis patients without overt hepatic encephalopathy randomized to receive either placebo or satavaptan, a vasopressin V 2 antagonist. The exposure was plasma sodium, and the outcome was the trail‐making test (TMT) parts A and B, which assesses speed of information processing, performed before the study starts and after 14 days. The results were analyzed by initial and change to final sodium concentration. Results At entry, the patients with normonatremia exhibited better results on both the TMT‐A (median 56 vs 77.5 s for patients with sodium ≤ 130 mmol/L [ P = 0.0059]) and the TMT‐B (median 127 vs 170 s for patients with sodium ≤ 130 mmol/L [ P = 0.0066]), unrelated to age. Improvement of hyponatremia was more common in patients who received satavaptan (59.7%) than placebo (18.5%). Correction of hyponatremia did not shorten the simple TMT‐A but markedly improved the complex TMT‐B by an average of 20 s compared with 6.5 s in those with continuing hyponatremia ( P = 0.02). Liver status measures remained stable during the period reported. Conclusions These data suggest that improvement of hyponatremia in patients with cirrhosis leads to an increase in the speed of complex information processing.