Hyponatremia as a Prognostic Marker in Cirrhosis: A Systematic Review of Its Role Beyond the Model for End-Stage Liver Disease in Predicting Mortality.

Authors

Mounika Kotte, Sally M Nashed, Aryan Raj, Vimi Bansal, Sunita Kumawat, Shaimaa Awad, Taha Khalid

Published in

Cureus. Volume 18. Issue 7. Pages e112069. Epub Jul 04, 2026.

Abstract

This systematic review evaluates the prognostic significance of hyponatremia in patients with cirrhosis across diverse clinical settings. A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, and Web of Science for studies published between January 2000 and December 2025, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a structured Population, Intervention, Comparison, and Outcomes (PICO) framework. Observational cohort studies assessing the association between serum sodium levels and mortality outcomes in adult patients with cirrhosis were included. Seven studies met the eligibility criteria, encompassing heterogeneous cohorts, including critically ill patients, transplant waitlist populations, and individuals with advanced disease states such as refractory ascites. Across the included studies, hyponatremia consistently emerged as an independent predictor of mortality, with prognostic significance observed across varying degrees of disease severity and clinical contexts. Notably, serum sodium demonstrated additional risk-stratification value beyond the Model for End-Stage Liver Disease (MELD) score, particularly among patients with lower MELD scores, suggesting its utility in identifying high-risk individuals who may otherwise be underestimated by conventional prognostic models. From a pathophysiological perspective, hyponatremia reflects underlying circulatory and neurohumoral dysfunction, integrating key features of decompensated liver disease into a single clinically measurable parameter. Despite heterogeneity in study design and definitions of hyponatremia, the included studies generally demonstrated moderate methodological quality. Collectively, these findings support the incorporation of serum sodium into prognostic assessment frameworks while emphasizing the need for cautious interpretation and further research focusing on dynamic sodium trends and multidimensional risk-prediction models.

PMID:
42553811
Bibliographic data and abstract were imported from PubMed on 05 Aug 2026.

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