Hyponatremia in Hepatocellular Carcinoma Complicating with Cirrhosis

Background and aims: We aimed to investigate the effect of serum sodium level on survival in hepatocellular carcinoma (HCC) patients complicating with liver cirrhosis (LC). Methods: A total of 1170 HCC patients with LC were analysed. We classified these patients into three groups according to serum sodium level at HCC diagnosis: group A (n=96); serum sodium <= 135 mmol/L, group B (n=520); 135 mmol/L < serum sodium <= 140 mmol/L, group C (n=554); serum sodium >140 mmol/L. We compared the baseline characteristics and overall survival (OS) among these three groups. Furthermore, we examined the factors linked to OS using univariate and multivariate analyses. Results: In our results, decreased baseline serum sodium level was significantly associated with Child-Pugh classification and HCC stage along with several laboratory parameters in groups A, B and C. The median follow-up period was 1.1 years in group A, 2.4 years in group B and 3.3 years in group C. The 1-, 3- and 5-year cumulative OS rates in groups A, B and C were 64.8%, 46.9% and 25.7%, respectively, in group A, 85.5%, 60.5% and 41.1%, respectively, in group B and 90.7%, 66.6% and 48.2%, respectively, in group C (P<0.001). The multivariate analyses showed that Child-Pugh classification (P<0.001), HCC stage (P<0.001), serum sodium (P<0.001), aspartate aminotransferase >= 57 IU/L (P=0.002), alkaline phosphatase >= 348 IU/L (P<0.001), alpha-fetoprotein >= 29.2 ng/mL (P=0.019) and des-gamma-carboxy prothrombin >= 55 mAU/mL (P<0.001) were significant independent predictors linked to OS. Conclusion: Lower serum sodium concentration is a useful predictor in HCC patients complicating with LC.