{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:02:25Z","timestamp":1790787745988,"version":"4.1.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":3196,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2006,12]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>\n                                 <jats:bold>Low serum sodium concentration is an independent predictor of mortality in patients with cirrhosis, but its prevalence and clinical significance is unclear. To evaluate prospectively the prevalence of low serum sodium concentration and the association between serum sodium levels and severity of ascites and complications of cirrhosis, prospective data were collected on 997 consecutive patients from 28 centers in Europe, North and South America, and Asia for a period of 28 days. The prevalence of low serum sodium concentration as defined by a serum sodium concentration \u2264135 mmol\/L, \u2264130 mmol\/L, \u2264125 mmol\/L, and \u2264120 mmol\/L was 49.4%, 21.6%, 5.7%, and 1.2%, respectively. The prevalence of low serum sodium levels (&lt;135 mmol\/L) was high in both inpatients and outpatients (57% and 40%, respectively). The existence of serum sodium &lt;135 mmol\/L was associated with severe ascites, as indicated by high prevalence of refractory ascites, large fluid accumulation rate, frequent use of large-volume paracentesis, and impaired renal function, compared with normal serum sodium levels. Moreover, low serum sodium levels were also associated with greater frequency of hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome, but not gastrointestinal bleeding. Patients with serum sodium &lt;130 mmol\/L had the greatest frequency of these complications, but the frequency was also increased in patients with mild reduction in serum sodium levels (131-135 mmol\/L).<\/jats:bold>\n                                 <jats:bold>\n                                    In conclusion\n                                 <\/jats:bold>\n                                 <jats:bold>, low serum sodium levels in cirrhosis are associated with severe ascites and high frequency of hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome.<\/jats:bold>\n                              <\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.21412","type":"journal-article","created":{"date-parts":[[2006,11,28]],"date-time":"2006-11-28T20:59:49Z","timestamp":1164747589000},"page":"1535-1542","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":342,"title":["Hyponatremia in cirrhosis: Results of a patient population survey"],"prefix":"10.1097","volume":"44","author":[{"given":"Paolo","family":"Angeli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugh","family":"Watson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pere","family":"Gin\u00e8s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-24-20241201","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/S0140-6736(56)90149-0","article-title":"Electrolyte and circulatory changes in terminal liver failure.","volume":"271","author":"Hecker","year":"1956","journal-title":"Lancet"},{"key":"R2-24-20241201","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/0002-9343(65)90042-2","article-title":"3rd, Gabuzda GJ. Renal failure in patients with cirrhosis of the liver. II. Factors influencing maximal urinary flow rate.","volume":"39","author":"Shear","year":"1965","journal-title":"Am J Med"},{"key":"R3-24-20241201","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/BF01095898","article-title":"Prognostic value of spontaneous hyponatremia in cirrhosis with ascites.","volume":"21","author":"Arroyo","year":"1976","journal-title":"Dig Dis Sci"},{"key":"R4-24-20241201","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1002\/hep.510280337","article-title":"Hyponatremia in cirrhosis: from pathogenesis to treatment.","volume":"8","author":"Gines","year":"1998","journal-title":"HEPATOLOGY"},{"key":"R5-24-20241201","doi-asserted-by":"crossref","first-page":"423","DOI":"10.7326\/0003-4819-96-4-413","article-title":"Role of vasopressin in abnormal water excretion in cirrhotic patients.","volume":"96","author":"Bichet","year":"1982","journal-title":"Ann Intern Med"},{"key":"R6-24-20241201","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1016\/0016-5085(85)90664-X","article-title":"Derangements of renal water handling in liver disease.","volume":"89","author":"Epstein","year":"1985","journal-title":"Gastroenterology"},{"key":"R7-24-20241201","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1002\/hep.1840080532","article-title":"Peripheral arteriolar vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis.","volume":"8","author":"Schrier","year":"1988","journal-title":"HEPATOLOGY"},{"key":"R8-24-20241201","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/0016-5085(88)90441-6","article-title":"Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites.","volume":"94","author":"Llach","year":"1988","journal-title":"Gastroenterology"},{"key":"R9-24-20241201","first-page":"261","article-title":"New classification with prognostic value in cirrhotic patients.","volume":"15","author":"Cosby","year":"1989","journal-title":"Miner Electrolyte Metab"},{"key":"R10-24-20241201","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S0168-8278(00)00011-8","article-title":"A prognostic model for predicting survival in cirrhosis with ascites.","volume":"34","author":"FernandezEsparrach","year":"2001","journal-title":"J Hepatol"},{"key":"R11-24-20241201","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1002\/hep.1840400409","article-title":"Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at risk for early death.","volume":"40","author":"Heuman","year":"2004","journal-title":"HEPATOLOGY"},{"key":"R12-24-20241201","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/hep.20517","article-title":"Serum sodium predicts mortality in patients listed for liver transplantation.","volume":"41","author":"Biggins","year":"2005","journal-title":"HEPATOLOGY"},{"key":"R13-24-20241201","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1002\/lt.20329","article-title":"Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone.","volume":"11","author":"Ruf","year":"2005","journal-title":"Liver Transpl"},{"key":"R14-24-20241201","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1053\/j.gastro.2006.02.010","article-title":"Evidencebased incorporation of serum sodium concentration into MELD.","volume":"130","author":"Biggins","year":"2006","journal-title":"Gastroenterology"},{"key":"R15-24-20241201","first-page":"164","article-title":"Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis.","volume":"23","author":"Arroyo","year":"1996","journal-title":"HEPATOLOGY"},{"key":"R16-24-20241201","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/S1590-8658(00)80844-0","article-title":"Clinical relevance of hyponatraemia for the hospital outcome of cirrhotic patients.","volume":"32","author":"Borroni","year":"2000","journal-title":"Digest Liver Dis"},{"key":"R17-24-20241201","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1001\/archinte.162.3.323","article-title":"Dilutional hyponatremia in patients with cirrhosis and ascites.","volume":"162","author":"Porcel","year":"2002","journal-title":"Arch Intern Med"},{"key":"R18-24-20241201","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/S0168-8278(02)00028-4","article-title":"Milestones in liver disease: Hecker R, Sherlock S. 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