The Outcome of Cirrhotic Patients with Ascites Is Improved by the Normalization of the Serum Sodium Level by Tolvaptan

Objective Hyponatremia is frequently observed in patients with decompensated liver cirrhosis and it is also related to a poor prognosis. The vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites and increases the serum sodium (Na) level. In this study, we inve...

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Published in:Internal Medicine 2017/11/15, Vol.56(22), pp.2993-3001
Main Authors: Kogiso, Tomomi, Kobayashi, Mutsuki, Yamamoto, Kuniko, Ikarashi, Yuichi, Kodama, Kazuhisa, Taniai, Makiko, Torii, Nobuyuki, Hashimoto, Etsuko, Tokushige, Katsutoshi
Format: Article
Language:English
Subjects:
Aged
Antidiuretic Hormone Receptor Antagonists - therapeutic use
Ascites
Ascites - complications
Benzazepines - therapeutic use
Brain natriuretic peptide
brain natriuretic peptide (BNP)
Cirrhosis
Female
Humans
Hyponatremia
Hyponatremia - complications
Hyponatremia - drug therapy
Internal medicine
Japan
Liver
Liver cirrhosis
Liver Cirrhosis - complications
Male
Medical prognosis
Middle Aged
Original
Patients
Prognosis
Retrospective Studies
Sodium
Sodium - blood
Survival
Tolvaptan
Treatment Outcome
Vasopressin
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container_volume 56
creator Kogiso, Tomomi
Kobayashi, Mutsuki
Yamamoto, Kuniko
Ikarashi, Yuichi
Kodama, Kazuhisa
Taniai, Makiko
Torii, Nobuyuki
Hashimoto, Etsuko
Tokushige, Katsutoshi
description Objective Hyponatremia is frequently observed in patients with decompensated liver cirrhosis and it is also related to a poor prognosis. The vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites and increases the serum sodium (Na) level. In this study, we investigated (i) whether or not correction of the Na level improves the prognosis of cirrhotic patients with ascites and (ii) predictors of normalization of the serum Na level after tolvaptan therapy. Methods This was a single-center retrospective study. A total of 95 Japanese cirrhotic patients (60 men, median age 63 years) were enrolled and received tolvaptan orally after hospitalization for ascites treatment. The serum Na level was monitored during the period of tolvaptan treatment. The laboratory data and survival rates of patients who achieved serum Na levels of
doi_str_mv 10.2169/internalmedicine.9033-17
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The vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites and increases the serum sodium (Na) level. In this study, we investigated (i) whether or not correction of the Na level improves the prognosis of cirrhotic patients with ascites and (ii) predictors of normalization of the serum Na level after tolvaptan therapy. Methods This was a single-center retrospective study. A total of 95 Japanese cirrhotic patients (60 men, median age 63 years) were enrolled and received tolvaptan orally after hospitalization for ascites treatment. The serum Na level was monitored during the period of tolvaptan treatment. The laboratory data and survival rates of patients who achieved serum Na levels of &lt;135 and ≥135 mEq/L after 1 week were compared. Results Patients showed serum Na levels of 136 (121-145) mEq/L, and 42.1% had a serum Na level of &lt;135 mEq/L. Among patients with an initial serum Na level &lt;135 mEq/L, 60.0% achieved a normal level after 1 week, and the survival rate was significantly higher in patients with a normalized serum Na level (p&lt;0.01). The pretreatment brain natriuretic peptide (BNP) level was predictive of achieving a serum Na level of ≥135 mEq/L (odds ratio: 0.87, 95% confidence interval: 0.316-0.987, p&lt;0.05). Conclusion Normalization of the Na level after one week was associated with a favorable outcome of tolvaptan therapy, and Na correction improved the prognosis.</description><identifier>ISSN: 0918-2918</identifier><identifier>EISSN: 1349-7235</identifier><identifier>DOI: 10.2169/internalmedicine.9033-17</identifier><identifier>PMID: 28943585</identifier><language>eng</language><publisher>Japan: The Japanese Society of Internal Medicine</publisher><subject>Aged ; Antidiuretic Hormone Receptor Antagonists - therapeutic use ; Ascites ; Ascites - complications ; Benzazepines - therapeutic use ; Brain natriuretic peptide ; brain natriuretic peptide (BNP) ; Cirrhosis ; Female ; Humans ; Hyponatremia ; Hyponatremia - complications ; Hyponatremia - drug therapy ; Internal medicine ; Japan ; Liver ; Liver cirrhosis ; Liver Cirrhosis - complications ; Male ; Medical prognosis ; Middle Aged ; Original ; Patients ; Prognosis ; Retrospective Studies ; Sodium ; Sodium - blood ; Survival ; Tolvaptan ; Treatment Outcome ; Vasopressin</subject><ispartof>Internal Medicine, 2017/11/15, Vol.56(22), pp.2993-3001</ispartof><rights>2017 by The Japanese Society of Internal Medicine</rights><rights>Copyright Japan Science and Technology Agency 2017</rights><rights>Copyright © 2017 by The Japanese Society of Internal Medicine 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c610t-b5b7744cb3fde8f777ad242527935eb0aac6edc6e034fe2e9f76cb1348e612ec3</citedby><cites>FETCH-LOGICAL-c610t-b5b7744cb3fde8f777ad242527935eb0aac6edc6e034fe2e9f76cb1348e612ec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725852/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725852/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28943585$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kogiso, Tomomi</creatorcontrib><creatorcontrib>Kobayashi, Mutsuki</creatorcontrib><creatorcontrib>Yamamoto, Kuniko</creatorcontrib><creatorcontrib>Ikarashi, Yuichi</creatorcontrib><creatorcontrib>Kodama, Kazuhisa</creatorcontrib><creatorcontrib>Taniai, Makiko</creatorcontrib><creatorcontrib>Torii, Nobuyuki</creatorcontrib><creatorcontrib>Hashimoto, Etsuko</creatorcontrib><creatorcontrib>Tokushige, Katsutoshi</creatorcontrib><title>The Outcome of Cirrhotic Patients with Ascites Is Improved by the Normalization of the Serum Sodium Level by Tolvaptan</title><title>Internal Medicine</title><addtitle>Intern. Med.</addtitle><description>Objective Hyponatremia is frequently observed in patients with decompensated liver cirrhosis and it is also related to a poor prognosis. The vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites and increases the serum sodium (Na) level. In this study, we investigated (i) whether or not correction of the Na level improves the prognosis of cirrhotic patients with ascites and (ii) predictors of normalization of the serum Na level after tolvaptan therapy. Methods This was a single-center retrospective study. A total of 95 Japanese cirrhotic patients (60 men, median age 63 years) were enrolled and received tolvaptan orally after hospitalization for ascites treatment. The serum Na level was monitored during the period of tolvaptan treatment. The laboratory data and survival rates of patients who achieved serum Na levels of &lt;135 and ≥135 mEq/L after 1 week were compared. Results Patients showed serum Na levels of 136 (121-145) mEq/L, and 42.1% had a serum Na level of &lt;135 mEq/L. Among patients with an initial serum Na level &lt;135 mEq/L, 60.0% achieved a normal level after 1 week, and the survival rate was significantly higher in patients with a normalized serum Na level (p&lt;0.01). The pretreatment brain natriuretic peptide (BNP) level was predictive of achieving a serum Na level of ≥135 mEq/L (odds ratio: 0.87, 95% confidence interval: 0.316-0.987, p&lt;0.05). 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Kobayashi, Mutsuki ; Yamamoto, Kuniko ; Ikarashi, Yuichi ; Kodama, Kazuhisa ; Taniai, Makiko ; Torii, Nobuyuki ; Hashimoto, Etsuko ; Tokushige, Katsutoshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c610t-b5b7744cb3fde8f777ad242527935eb0aac6edc6e034fe2e9f76cb1348e612ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Antidiuretic Hormone Receptor Antagonists - therapeutic use</topic><topic>Ascites</topic><topic>Ascites - complications</topic><topic>Benzazepines - therapeutic use</topic><topic>Brain natriuretic peptide</topic><topic>brain natriuretic peptide (BNP)</topic><topic>Cirrhosis</topic><topic>Female</topic><topic>Humans</topic><topic>Hyponatremia</topic><topic>Hyponatremia - complications</topic><topic>Hyponatremia - drug therapy</topic><topic>Internal medicine</topic><topic>Japan</topic><topic>Liver</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Sodium</topic><topic>Sodium - blood</topic><topic>Survival</topic><topic>Tolvaptan</topic><topic>Treatment Outcome</topic><topic>Vasopressin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kogiso, Tomomi</creatorcontrib><creatorcontrib>Kobayashi, Mutsuki</creatorcontrib><creatorcontrib>Yamamoto, Kuniko</creatorcontrib><creatorcontrib>Ikarashi, Yuichi</creatorcontrib><creatorcontrib>Kodama, Kazuhisa</creatorcontrib><creatorcontrib>Taniai, Makiko</creatorcontrib><creatorcontrib>Torii, Nobuyuki</creatorcontrib><creatorcontrib>Hashimoto, Etsuko</creatorcontrib><creatorcontrib>Tokushige, Katsutoshi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Internal Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kogiso, Tomomi</au><au>Kobayashi, Mutsuki</au><au>Yamamoto, Kuniko</au><au>Ikarashi, Yuichi</au><au>Kodama, Kazuhisa</au><au>Taniai, Makiko</au><au>Torii, Nobuyuki</au><au>Hashimoto, Etsuko</au><au>Tokushige, Katsutoshi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Outcome of Cirrhotic Patients with Ascites Is Improved by the Normalization of the Serum Sodium Level by Tolvaptan</atitle><jtitle>Internal Medicine</jtitle><addtitle>Intern. Med.</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>56</volume><issue>22</issue><spage>2993</spage><epage>3001</epage><pages>2993-3001</pages><issn>0918-2918</issn><eissn>1349-7235</eissn><abstract>Objective Hyponatremia is frequently observed in patients with decompensated liver cirrhosis and it is also related to a poor prognosis. The vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites and increases the serum sodium (Na) level. In this study, we investigated (i) whether or not correction of the Na level improves the prognosis of cirrhotic patients with ascites and (ii) predictors of normalization of the serum Na level after tolvaptan therapy. Methods This was a single-center retrospective study. A total of 95 Japanese cirrhotic patients (60 men, median age 63 years) were enrolled and received tolvaptan orally after hospitalization for ascites treatment. The serum Na level was monitored during the period of tolvaptan treatment. The laboratory data and survival rates of patients who achieved serum Na levels of &lt;135 and ≥135 mEq/L after 1 week were compared. Results Patients showed serum Na levels of 136 (121-145) mEq/L, and 42.1% had a serum Na level of &lt;135 mEq/L. Among patients with an initial serum Na level &lt;135 mEq/L, 60.0% achieved a normal level after 1 week, and the survival rate was significantly higher in patients with a normalized serum Na level (p&lt;0.01). The pretreatment brain natriuretic peptide (BNP) level was predictive of achieving a serum Na level of ≥135 mEq/L (odds ratio: 0.87, 95% confidence interval: 0.316-0.987, p&lt;0.05). Conclusion Normalization of the Na level after one week was associated with a favorable outcome of tolvaptan therapy, and Na correction improved the prognosis.</abstract><cop>Japan</cop><pub>The Japanese Society of Internal Medicine</pub><pmid>28943585</pmid><doi>10.2169/internalmedicine.9033-17</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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subjects Aged
Antidiuretic Hormone Receptor Antagonists - therapeutic use
Ascites
Ascites - complications
Benzazepines - therapeutic use
Brain natriuretic peptide
brain natriuretic peptide (BNP)
Cirrhosis
Female
Humans
Hyponatremia
Hyponatremia - complications
Hyponatremia - drug therapy
Internal medicine
Japan
Liver
Liver cirrhosis
Liver Cirrhosis - complications
Male
Medical prognosis
Middle Aged
Original
Patients
Prognosis
Retrospective Studies
Sodium
Sodium - blood
Survival
Tolvaptan
Treatment Outcome
Vasopressin
title The Outcome of Cirrhotic Patients with Ascites Is Improved by the Normalization of the Serum Sodium Level by Tolvaptan
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