Hyponatremia as a predictor of in-hospital mortality in cirrhotic and non-cirrhotic hepatocellular carcinoma patients.

Abstract

e16226 Background: Hepatocellular carcinoma (HCC), the most common primary liver cancer, accounts for 75–85% of liver cancer cases. Cirrhosis, a major risk factor for HCC, is often associated with hyponatremia, which contributes to worse clinical outcomes in cirrhotic patients. The prognostic role of hyponatremia in non-cirrhotic HCC remains unclear. This study evaluates the impact of hyponatremia on in-hospital mortality in HCC patients with and without cirrhosis. Methods: We conducted a retrospective analysis using the National Inpatient Sample (NIS) (2016-2020). A study protocol was developed prior to implementation. Inclusion criteria were a primary or secondary HCC diagnosis, presence or absence of cirrhosis, and hyponatremia, as defined by ICD-10 codes. The primary endpoint was in-hospital mortality. Missing data were excluded, and multivariate logistic regression adjusted for confounders (age, sex, race, comorbidities, and hospital characteristics). Statistical analyses were performed using STATA. Results: From 2016–2020, 50,155 patients with HCC and cirrhosis and 43,565 with HCC without cirrhosis were identified, with hyponatremia during hospitalization. Among patients with hyponatremia in HCC with cirrhosis, 76.5% were male, 23.5% were female and 54.8% were aged 46–65 years (p < 0.001). For HCC without cirrhosis, proportion of patients with hyponatremia was similar between sexes (p = 0.25), with 58.9% cases occurring in patients aged > 65 years (p < 0.001). Racial distribution differed significantly: in HCC with cirrhosis and hyponatremia, Whites accounted for the largest proportion (56.6%), followed by Hispanics (20.0%), Asians/Pacific Islanders (12.9%), and Blacks (10.5%) (p < 0.001). In non-cirrhotic HCC with hyponatremia, Whites represented the largest proportion (60.4%), followed by Asians/Pacific Islanders (15.1%), Hispanics (12.8%) and Blacks (11.7%) (p < 0.001). In-hospital mortality was higher in patients with hyponatremia: 12.7% for HCC with cirrhosis (vs. 8.5% in absence of hyponatremia) and 12% for HCC without cirrhosis (vs. 8.2% without hyponatremia) (p < 0.001 for both). Hyponatremia increased the risk of in-hospital mortality by 31% in HCC with cirrhosis (adjusted odds ratio [aOR] = 1.31, p < 0.001) and by 21% in HCC without cirrhosis (aOR = 1.21, p < 0.001). Hyponatremia also prolonged hospital stay by two days in both groups. Conclusions: Hyponatremia is an independent predictor of increased in-hospital mortality in HCC, with a greater impact in cirrhotic patients. Early recognition and management of hyponatremia may improve outcomes in HCC patients. Racial differences in the distribution of hyponatremia between cirrhotic and non-cirrhotic HCC patients highlight the need for further research into potential genetic, disease-related, healthcare, and socioeconomic factors.