Study of hyponatremia and serum uric acid levels in cirrhosis of liver and its prognostic value

Abstract

Background:

Cirrhosis of the liver represents the end stage of chronic hepatic injury and remains a major cause of morbidity and mortality worldwide. Hyponatremia and hyperuricemia are common biochemical abnormalities in advanced cirrhosis, reflecting disturbances in circulatory and renal function. Their combined assessment may provide valuable prognostic information, especially in resource-limited settings.

Objectives:

To evaluate the prevalence of hyponatremia and hyperuricemia in patients with cirrhosis of the liver and to correlate these parameters with disease severity using the Child–Turcotte–Pugh (CTP) classification.

Methods:

A hospital-based cross-sectional observational study was conducted on 100 adult patients with clinically and sonographically diagnosed cirrhosis admitted to General Hospital Jayanagar, Bengaluru, between January 2022 and December 2023. Serum sodium and uric acid levels were measured using ion-selective electrode and uricase–peroxidase methods, respectively. Hyponatremia was defined as serum sodium < 135 mEq/L, and hyperuricemia as uric acid > 7 mg/dL in males and > 6 mg/dL in females. The severity of liver disease was graded using the CTP score. Statistical analysis included ANOVA and Pearson’s correlation.

Results:

The mean age of patients was 49.8 ± 11.6 years, with male predominance (72%). Alcoholic liver disease was the most common etiology (60%). Hyponatremia was present in 70% of patients—mild in 33%, moderate in 25%, and severe in 12%—with mean serum sodium levels declining significantly from 135.6 ± 3.1 mEq/L in CTP A to 126.9 ± 4.1 mEq/L in CTP C (p < 0.001). The mean serum uric acid level was 8.9 ± 2.4 mg/dL, with 65% of patients showing hyperuricemia; levels increased progressively across CTP classes (A: 6.4 mg/dL; B: 8.3 mg/dL; C: 10.2 mg/dL; p < 0.001). A strong inverse correlation was observed between serum sodium and uric acid (r = –0.845, p < 0.001). Both abnormalities were significantly associated with complications such as ascites, hepatic encephalopathy, coagulopathy, and short-term mortality (6%), all occurring in patients with advanced (CTP C) disease.

Conclusions:

Hyponatremia and hyperuricemia are prevalent in cirrhosis and correlate strongly with disease severity and complications. Their inverse relationship reflects shared pathophysiological mechanisms involving circulatory dysfunction and impaired renal handling. Routine measurement of these inexpensive markers can aid in prognostication and early risk stratification in patients with decompensated cirrhosis