Early change in serum sodium level is associated with prognosis in patients with liver cirrhosis and refractory ascites treated by tolvaptan

Abstract

Tolvaptan, vasopressin V2-receptor antagonist, is an effective treatment for refractory ascites due to cirrhosis, whereas it is indicated for hyponatremia in Western countries. We investigated the association early changes in serum sodium concentration after starting tolvaptan with the prognosis. A total of 78 cirrhotic patients without hepatocellular carcinoma, who were treated with tolvaptan for refractory ascites, were enrolled. The therapeutic effect was defined as a weight loss of 1.5 kg or more after 7 days. Baseline serum sodium concentration was not associated with treatment response, but it significantly increased after 6 hours and 24 hours regardless of treatment response. Hyponatremia was observed in 37.2% before starting tolvaptan, but it decreased to 17.6% after 24 hours. Multivariate analysis revealed that serum sodium concentration after 24 hours was associated with the prognosis, along with liver function and furosemide dosage. In particular, hyponatremia after 24 hours had a poor prognosis regardless of the therapeutic effect on ascites. In conclusion, our study revealed that hyponatremia was observed in approximately 40% of patients with decompensated liver cirrhosis with refractory ascites and improved early regardless of the therapeutic effect of tolvaptan, but hyponatremia after 24 hours after starting tolvaptan was significantly associated with poor prognosis.