Association of Hyponatremia and Risk of Short- and Long-Term Mortality in Patients with Stroke: A Systematic Review and Meta-Analysis

Chen, Zhongyun; Jia, Qingxia; Liu, Chunyan

doi:10.1016/j.jstrokecerebrovasdis.2019.02.021

Cited by 26 publications

(25 citation statements)

References 35 publications

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“…Although hyponatremia has gained wide recognition as a predictor of long-term mortality after stroke, the effect of hyponatremia on short-term mortality was inconsistent (14-17). Rodrigues et al and a meta-analysis study reported that hyponatremia was related to increased mortality inhospital and at 3 months in IS patients (14,15). Whereas two other studies showed that hyponatremia was not associated with either in-hospital, 30-day or 90-day mortality after IS (16,17).…”

Section: Discussionmentioning

confidence: 97%

“…Moreover, we also found hyponatremia was associated with poor functional outcomes of AIS or TIA, which has not been investigated well in previous studies. Mechanisms of the enhanced mortality and poor functional outcomes in hyponatremic patients would be hyponatremia may promote cerebral edema, increase intracranial pressure and then affect cerebral perfusion, which led to vascular injury after stroke (15,23,29).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated that these electrolyte disorders were also closely related to the prognosis of heart failure (6), acute coronary syndrome (7), chronic kidney disease (8), hypertension (9) intracerebral hemorrhage (8), and acute pancreatitis (10). Although some studies have investigated the prognosis role of hypokalemia, hyponatremia, and hypochloremia in stroke, the sample size was small and the results were conflicting (11)(12)(13)(14)(15)(16)(17). Furthermore, limited data from large multicenter prospective studies were available to evaluate the role of electrolytes in the prognosis of stroke, and the associations of each electrolyte category with short-and long-term outcomes in patients with stroke have not been investigate well.…”

Section: Introductionmentioning

confidence: 99%

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Electrolytes and clinical outcomes in patients with acute ischemic stroke or transient ischemic attack

Wang

Tian

et al. 2021

Ann Transl Med

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Background: Abnormal electrolytes were closely related to the prognosis of various diseases, the prognostic role of electrolytes in stroke has not been investigated well. We aimed to investigate the association between electrolytes and clinical outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA).Methods: Data were recruited from the China National Stroke Registry III study. Patients were classified into three groups according to tertiles and the normal range of each electrolyte. Multivariable logistic and Cox proportional hazards regressions were adopted to explore the associations of electrolytes with poor functional outcomes [modified Rankin Scale (mRS) 3-6/2-6] and all-cause death at 3 months and 1 year.Results: A total of 10,299 eligible patients were enrolled. After adjusted for confounding factors, the first tertile electrolytes were associated with increased risk of poor functional outcome (mRS score 3-6) at 1 year, the adjusted odds ratios (95% confidence intervals) were 1.33 (1.14-1.55) for potassium, 1.41 (1.20-1.60) for sodium, 1.27 (1.08-1.48) for chloride, compared with the second tertile. Similar results were found when poor functional outcome was defined as mRS score 2-6 and all-cause death. However, almost no significant association was present of calcium with these outcomes. All results were consistent when each electrolyte was classified into three groups according to the normal range and the outcomes timepoint was set at 3 months.Conclusions: Lower levels of potassium, sodium, chloride but not calcium were associated with higher risk of poor functional outcomes and death in patients with AIS or TIA.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electrolytes and clinical outcomes in patients with acute ischemic stroke or transient ischemic attack

Wang

Tian

et al. 2021

Ann Transl Med

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“…Normal symptoms for patients with hyponatremia include dizziness, disturbed alertness and confusion, which increases the risk of falls (29). Patients with hyponatremia have longer stays, more readmissions and increased mortality (30)(31)(32)39). One of the major causes of hyponatremia is diuretic therapy, often in combination with psychoactive drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Electrolyte disturbances are also frequent among elderly patients, and hyponatremia is most common (28). Changes in electrolyte concentration affects alertness, reduces cognition (29) and increases mortality (30,31). For patients with chronic kidney disease, hyponatremia will worsen the prognosis (32).…”

mentioning

confidence: 99%

Risk factors for one-year all-cause mortality in elderly multimorbid medical in-patients.

Wang-Hansen

Kersten

Wyller³

2020

Preprint

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Background: Due to expansion of longevity, the proportion of elderly people with multimorbidity is increasing. Our aim was to identify risk factors for all-cause mortality in elderly multimorbid medical in-patients one year after acute hospitalization. Information regarding risk factors is important to support targeted care plans after discharge. Methods: Prospective cohort study of patients acutely admitted to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, received home care services before hospitalization, were aged 75+, and suffered from two or more chronic conditions. Inclusion period was 1. April – 31. October 2012. Candidate variables were number of daily prescribed drugs, Cumulative Illness Rating Scale for Geriatrics score, delirium, body mass index (BMI), handgrip strength, Barthel Activities of Daily Living Index score, and the laboratory analyses haemoglobin (Hgb), sodium (Na) and estimated glomerular filtration rate (eGFR). Results: We included 227 patients; mean age 86 years, 59% women, 71% lived alone. During the year after hospitalization, 39% died. In the adjusted cox proportional hazards regression analysis, significant and independent risk factors were BMI (hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.88-0.98 per kg/m2), Hgb (HR 0.87, 95% CI 0.76-0.98 per g/100 mL), Na (HR 0.94, 95% CI 0.90-0.99 per mmol/L) and eGFR < 60 mL/min/1.73 m2 (HR 1.82, 95% CI 1.07-3.08).Conclusions: In this cohort of multimorbid elderly internal medicine patients, low body mass, hyponatremia, impaired renal function and anaemia were identified as independent and significant risk factors for one-year mortality.

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Comparison of the Incidence and Magnitude of Hyponatremia Among Patients With Poststroke Depression Receiving Either Escitalopram or Sertraline

Naseralallah,

Noureddine,

Koryash

2024

Pharmacology Res & Perspec

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Depression is the most frequent psychiatric condition experienced in stroke survivors. Selective serotonin reuptake inhibitors (SSRIs) are frequently used as first‐line antidepressants; however, they have been strongly associated with hyponatremia which, in poststroke patients, can worsen outcomes. This study aims to determine and compare the incidence and magnitude of hyponatremia and potential risk factors in patients receiving either escitalopram or sertraline for the management of poststroke depression (PSD). A retrospective observational study involving all hospitalized patients who received either escitalopram or sertraline for the treatment of PSD. Electronic medical records were reviewed over a 5‐year period with data collected on various demographic, laboratory, comorbidity, and medication‐related variables. Data were analyzed using multivariate logistic regression. A total of 401 patients met the inclusion criteria. Overall, 36.7% of patients experienced hyponatremia, with 67 (38.3%) cases in patients receiving escitalopram and 76 (33.6%) in sertraline group. The median drop in sodium level from baseline was 5 mmol/L in both groups; with the majority of cases being of mild nature (73.1% and 69.7% for escitalopram and sertraline, respectively). Findings from the multivariate logistic regression did not yield a model with significant association (p = 0.353). Escitalopram and sertraline were both associated with an increased risk of hyponatremia in poststroke patients, with most cases being mild. There was no significant difference between treatment arms regarding the incidence or magnitude of hyponatremia. Caution should be exercised when prescribing escitalopram or sertraline.

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Association of Hyponatremia and Risk of Short- and Long-Term Mortality in Patients with Stroke: A Systematic Review and Meta-Analysis

Cited by 26 publications

References 35 publications

Electrolytes and clinical outcomes in patients with acute ischemic stroke or transient ischemic attack

Electrolytes and clinical outcomes in patients with acute ischemic stroke or transient ischemic attack

Risk factors for one-year all-cause mortality in elderly multimorbid medical in-patients.

Comparison of the Incidence and Magnitude of Hyponatremia Among Patients With Poststroke Depression Receiving Either Escitalopram or Sertraline

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