Abstract :
Background: Management of cirrhotic patients with ascites is based on improving excretion of sodium
(24-hr UNa excretion >78 mmol/d) with diuretics and dietary Na restriction. The spot UNa/K ratio may replace the cumbersome 24-hr urine collection but only few data have been confirmed.
Objective: To compare the diagnostic value of spot UNa/K ratio ?1 with 24-hr UNa ?78 mmol/day in
cirrhotic patients with ascites.
Patients and Methods: Seventy-three cirrhotic outpatients with ascites were recruited in the study.
Cirrhotic patients were classified as Child A 8.3%, Child B 61.7% and Child C 30.0%. 24-hr UNa, urine creatinine and spot UNa/K ratio were measured and analyzed.
Results: Sixty urine specimens were (82%) collected and completely analyzed. Mean of 24-hr UNa
was 146.7 +/- 92.7 mmol (range 22-404 mmol). Forty-five (75%) of 24-hr urine specimens contained ?78 mmol of Na/d. Fifty one (85%) of specimens had UNa/K ratio ?1. When compared with 24-hr UNa ?78 mmol, sensitivity, specificity, PPV, NPV of spot UNa/K ratio ?1 was 82%, 6%, 72% and 11%, respectively. From the ROC curve, the best cut off point was UNa/K ratio = 3. We found that the sensitivity was 44% and specificity was 73%.
Conclusions : The spot UNa/K ratio ?1 has a good sensitivity but very low specificity to predict adequate 24-hr UNa excretion. Even at the best cut off point at 3, it still had low sensitivity and specificity. There fore, 24-hr UNa collection remains the gold standard for the management of cirrhotic patients with ascites.
[Thai J Gastroenterol 2006; 7(2): 66-70] |
file/Thai-Journal-of-gastroenterology-vol-7-no-2-969257.pdf