Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2020; 12(2): 45-54
Published online Feb 27, 2020. doi: 10.4240/wjgs.v12.i2.45
Hyponatremia is associated with more severe biliary disease
Michael John Zobel, Lygia Stewart
Michael John Zobel, Lygia Stewart, Department of Surgery, University of California San Francisco, San Francisco, CA 94143, United States
Lygia Stewart, Department of Surgery, San Francisco VA Medical Center, San Francisco, CA 94121, United States
Author contributions: Zobel MJ and Stewart L designed the research, performed the research, contributed analytic tools, analyzed the data, and wrote the paper.
Institutional review board statement: This study was exempt from IRB approval as patient data was anonymously collected and not associated with any identifying information.
Informed consent statement: No consent was needed for this study.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lygia Stewart, MD, Professor, Surgeon, Chief Surgeon, Department of Surgery, University of California San Francisco, 4150 Clement Street, San Francisco, CA 94143, United States. lygia.stewart@va.gov
Received: September 5, 2019
Peer-review started: September 5, 2019
First decision: October 13, 2019
Revised: November 4, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: February 27, 2020
Processing time: 132 Days and 10.8 Hours
Abstract
BACKGROUND

Sodium level is an important clinical predictor of complex biliary disease. Hyponatremia has been observed in conjunction with biliary disease, however the nature of this association remains unclear.

AIM

To investigate the association between serum sodium and severe biliary disease.

METHODS

Of 920 patients with gallstone disease treated at the SFVA Hospital from 1989-2019 were studied. We conducted multivariate analyses of correlation between sodium level and biliary disease severity, the presence/location of biliary bacteria, and other factors. Minimum sodium level pre-intervention was collected. Gallstones, bile, and blood (as relevant) were cultured. Illness severity was characterized: (1) None (no infectious manifestations); (2) Systemic inflammatory response syndrome; (3) Severe illness (gangrenous cholecystitis, cholangitis, necrotizing pancreatitis); and (4) Multiple organ dysfunction syndrome (bacteremia, hypotension, organ failure). Comorbidity was defined using the Charlson Comorbidity Index (CCI).

RESULTS

Decreased sodium level significantly correlated with worsening illness severity, ascending bacterial infection, gangrenous changes, elevated CCI score, increasing age, male sex, and glucose. On multivariate analysis, all factors, except age, gender and glucose, independently correlated with sodium level and factors were additive.

CONCLUSION

This unique study is the first to explore, with such granularity, the relationship between biliary disease and sodium. No prior studies have examined specific culture and clinical data. It illustrates an inverse, independent correlation between illness severity and sodium. Culture data demonstrate that sodium decreases as infection ascends from gallstone colonization to bactibilia to bacteremia. Patient comorbidity and gangrenous changes also independently correlate with sodium on multivariate analysis. Sodium level is an important clinical indicator of disease severity for patients with biliary disease.

Keywords: Hyponatremia; Biliary disease; Cholecystitis; Cholangitis; Sodium; Sepsis

Core tip: This unique study is the first to explore, with such granularity, the relationship between biliary disease and sodium. No prior studies have examined specific culture and clinical data. It demonstrates an inverse, independent correlation between illness severity and sodium. Culture data demonstrate that sodium decreases as infection ascends from gallstone colonization to bactibilia to bacteremia. Patient comorbidity and gangrenous changes also independently correlate with sodium on multivariate analysis. Sodium level is an important clinical indicator of disease severity for patients with biliary disease.