Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?

Abstract

Several studies have demonstrated the impact of dysnatremias on mortality of intensive care unit (ICU) patients. The objective of this study was to assess whether dysnatremia is an independent factor to predict mortality in surgical critically ill patients admitted to ICU in postoperative phase.One thousand five hundred and ninety-nine surgical patients (58.8% males; mean age of 60.6 ± 14.4 years) admitted to the ICU in the postoperative period were retrospectively studied. The patients were classified according to their serum sodium levels (mmol/L) at admission as normonatremia (135–145), hyponatremia (<135), and hypernatremia (>145). APACHE II, SAPS III, and SOFA were recorded. The capability of each index to predict mortality of ICU and hospital mortality of patients was analyzed by multiple logistic regression.Hyponatremia did not have an influence on mortality in the ICU with a relative risk (RR) = 0.95 (0.43–2.05) and hospital mortality of RR = 1.40 (0.75–2.59). However, this association was greater in patients with hypernatremia mortality in the ICU (RR = 3.33 [95% confidence interval, CI 1.58–7.0]) and also in hospital mortality (RR = 2.9 [ 95% CI = 1.51–5.55). The pairwise comparison of ROC curves among the different prognostic indexes (APACHE II, SAPS III, SOFA) did not show statistical significance. The comparison of these indexes with serum sodium levels for general population, hyponatremia, and normonatremia was statistically significant (P < .001). For hypernatremia, the AUC and 95% CI for APACHE II, SAPS III, SOFA, and serum sodium level were 0.815 (0.713–0.892), 0.805 (0.702–0.885), 0.885 (0.794–0.945), and 0.663 (0.549–0.764), respectively. The comparison among the prognostic indexes was not statistically significant. Only SOFA score had a statistic difference compared with hypernatremia (P < .02).The serum sodium levels at admission, especially hypernatremia, may be used as an independent predictor of outcome in the surgical critically ill patients.

Preoperative risk factors including serum levels of potassium, sodium, and creatinine for early mortality after open abdominal surgery: a retrospective cohort study

“…Our findings are in line with previous findings from patients undergoing orthopedic surgery [ 26 – 29 ]. However, little is published about preoperative electrolyte and creatinine levels and mortality risk following open abdominal surgery [ 21 – 24 ].…”

Retrospective evaluation of the association between hyponatremia and neurological dysfunction in hospitalized foals (2012‐2016): 109 cases

“…It has frequently been assumed that marked deviations from the tightly regulated normal Na + concentrations are a marker of disease severity, rather than a direct contributor to mortality . However, recent studies in critically ill people have identified dysnatremias as independent predictors of mortality, and a study in cats and dogs found a linear association between the magnitude of hyponatremia and case fatality. Only hyponatremic foals were included in the study, as was the case in Collins’ study, and a comparison with normonatremic animals could therefore not be conducted.…”

ICU-Acquired Hypernatremia Is Associated with Persistent Inflammation, Immunosuppression and Catabolism Syndrome

“…Depending on the type of intensive care unit (ICU), 2–6% of patients are hypernatremic on admission and up to 7–26% develop hypernatremia during treatment—predominantly within the first week [ 9 , 10 , 11 , 12 , 13 , 14 ]. Regardless of whether it was present at admission or acquired during intensive care, hypernatremia has been shown to be a predictor and independent risk factor for mortality by numerous studies in various situations [ 9 , 12 , 13 , 15 , 16 ].…”