Association Between Hyponatremia and Higher Bronchiolitis Severity Among Children in the ICU With Bronchiolitis

Abstract

Background It remains unclear whether hyponatremia independently predicts a higher severity in children with bronchiolitis. Objective To investigate the association between hyponatremia and bronchiolitis severity in children hospitalized to the intensive care unit (ICU) for bronchiolitis. Methods We conducted a 16-center, prospective cohort study of hospitalized children age <2 years with bronchiolitis during the winters of 2007 to 2010. We classified patients into two groups: normonatremia (135–145 mEq/L) and hyponatremia (<135 mEq/L) based on the first-measured serum sodium concentration on the day of hospitalization. Outcomes were use of mechanical ventilation and ICU length-of-stay (LOS). To examine the association of sodium status with outcomes, we fit logistic and linear regression models with propensity score adjustment. Results Of 231 children hospitalized to the ICU for bronchiolitis, 193 patients (84%) were categorized into the normonatremia group, and 38 children (16%) into hyponatremia group. Compared to children with normonatremia, those with hyponatremia had higher risks of mechanical ventilation use (40% vs. 58%; P=0.04) and longer ICU LOS (median, 3 days vs. 6 days; P=0.007). Likewise, in the adjusted analyses, children with hyponatremia had significantly higher risks of mechanical ventilation use (OR, 2.14; 95%CI, 1.03–4.48; P=0.04) and longer ICU LOS (β-coefficient 2.21 days; 95%CI, 0.68–3.73 days; P=0.003). Conclusions In this prospective, multicenter study of children hospitalized for bronchiolitis, hyponatremia on the day of hospitalization was associated with a higher severity. Our data support hyponatremia as a prognostic factor that might improve the ability of clinicians to predict the disease course of children with severe bronchiolitis.

Association of nasopharyngeal microbiota profiles with bronchiolitis severity in infants hospitalised for bronchiolitis

“…First, we repeated the analysis stratifying by viral pathogen, similar to the approach used in prior studies (4, 34, 35). Second, we modeled length-of-stay as a count variable by fitting a mixed-effects Poisson regression model.…”

Factors predicting length of stay in bronchiolitis

“…Laboratory findings have been investigated as possible predictors or LOS and disease severity. Hyponatremia (blood sodium levels <135 mmol/L) is common among patients with respiratory infections, and was associated with higher severity of disease in children with bronchiolitis admitted to the Pediatric Intensive Care Unit (PICU) [13]. Additionally, children with higher C-Reactive Protein (CRP) values had higher admission rates to the PICU, longer LOS and higher duration of need for supplemental oxygen [14].…”

Hyponatremia in infants with new onset moderate-severe bronchiolitis: A cross-sectional study

“…Sodium analysis has evolved, in the last 20 years, from flame photometry to indirect and, more recently, direct potentiometry [2]. Currently available data in infants with moderate-severe bronchiolitis [3][4][5][6] rely on flame photometry or indirect potentiometry and point out a cumulative prevalence of 28% (134 out of 482 infants). The International Federation of Clinical Chemistry and Laboratory Medicine currently recommends the direct potentiometric method, which is insensitive to altered lipid or protein levels [2].…”