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Development of hyponatremia after terlipressin in cirrhotic patients with acute gastrointestinal bleeding: a retrospective multicenter observational study.

Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang, China. Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China. State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China. Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China. Department of Hepatobiliary Disease, 900 Hospital of the Joint Logistics Team (formerly Called Fuzhou General Hospital), Fuzhou, China. Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China. Department of Critical Care Medicine, The Sixth People's Hospital of Shenyang, Shenyang, China. Department of Biological Therapy, The Fifth Medical Center of PLA General Hospital, Beijing, China. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China. Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang, China. Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu, China. Department of Gastroenterology, Xi'an Central Hospital, Xi'an, China. Department of Gastroenterology, Air Force Hospital of Northern Theater Command, Shenyang, China.

Expert opinion on drug safety. 2020;(5):641-647
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Abstract

Background: Terlipressin can effectively control acute gastrointestinal bleeding (GIB) in cirrhotic patients by acting on the V1 receptors, but may lead to the development of dilutional hyponatremia by acting on the V2 receptors.Research design and methods: This retrospective multicenter study enrolled 674 cirrhotic patients with acute GIB in whom serum sodium concentrations were tested before and during the use of terlipressin. ΔSodium reduction ≥5 mmol/L, hyponatremia (sodium <130 mmol/L), and severe hyponatremia (sodium <125 mmol/L) during the use of terlipressin were evaluated. Logistic regression analyses were employed to identify the risk factors.Results: The incidence of Δsodium reduction ≥5 mmol/L, hyponatremia, and severe hyponatremia was 37.1%, 26.3%, and 13.0%, respectively. All of them were not significantly associated with in-hospital mortality (p = 0.973; p = 0.789; p = 0.887). In multivariate logistic regression analyses, the independent risk factors of Δsodium reduction ≥5 mmol/L were higher baseline sodium concentration, lower serum creatinine and prothrombin time, and larger dosage of terlipressin; those of hyponatremia were lower baseline sodium concentration and longer duration of terlipressin; those of severe hyponatremia were lower baseline sodium concentration and prothrombin time and longer duration of terlipressin.Conclusions: Hyponatremia was common in cirrhotic patients with acute GIB treated with terlipressin, but might not significantly increase the in-hospital mortality.

Methodological quality

Publication Type : Multicenter Study ; Observational Study

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