Hyponatremia is an independent risk factor for mortality from hepatitis B virus-associated acute-on-chronic liver failure

Introduction: Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) has a poor prognosis. This analysis aimed to assess whether hyponatremia has any prognostic value for patients with HBV-ACLF. Methods: We performed an analysis of the "Study on HBV-ACLF treated with integrated traditional Chinese and Western Medicine" (2012ZX10005-005) database. From 1059 patients admitted to 17 Chinese centers with suspected HBV-ACLF, we identified 567 who fulfilled the criteria of HBV-ACLF established by the Asia Pacific Association for the Study of the Liver in 2014. Results: Of 567 patients, 45.5% had hyponatremia at inclusion. These patients exhibited significantly greater liver impairment (as indicated by higher levels of serum bilirubin, international normalized ratio, aspartate transaminase, alanine transaminase, gamma-glutamyl transferase and lactate dehydrogenase, and a lower level of cholinesterase), higher serum creatinine, and lower serum lipid levels compared to the HBV-ACLF patients without hyponatremia. After adjusting for potential confounders, hyponatremia at inclusion was an independent risk factor for mortality, nearly doubling the risk of death by 48 weeks (hazard ratio [95% CI], 1.827 [1.036-3.221]; P = 0.037). Only 51.4% of the HBV-ACLF patients with hyponatremia achieved 48-week transplant-free survival compared to 65.9% without hyponatremia (P < 0.001). Conclusion: Hyponatremia is an independent risk factor for mortality in patients with HBV-ACLF.