Electrolyte and acid-base disorders in cancer patients and its impact on clinical outcomes: evidence from a real-world study in China

Abstract

Background: This study aims to delineate the incidence of electrolyte and acid-base disorders (EAD) in cancer patients, to figure out the risk factors of EAD, then to assess the impact of EAD on patients' in-hospital clinical outcomes. Methods: Patients with the diagnosis of malignancies hospitalized during 1 October 2014 and 30 September 2015 were recruited in Zhongshan Hospital, Fudan University in Shanghai of China. Demographic characteristics, comorbidities, and clinical data, including survival, length of stay and hospital cost, were extracted from the electronic medical record system. Electrolyte and acid-base data were acquired from the hospital laboratory database. Results: Of 25,881 cancer patients with electrolyte data, 15,000 (58.0%) cases had at least one electrolyte and acid-base abnormity. Hypocalcemia (27.8%) was the most common electrolyte disorder, followed by hypophosphatemia (26.7%), hypochloremia (24.5%) and hyponatremia (22.5%). The incidence of simple metabolic acidosis (MAC) and metabolic alkalosis (MAL) was 12.8% and 22.1% respectively. Patients with mixed metabolic acid-base disorders (MAC þ MAL) accounted for 30.2%. Lower BMI score, preexisting hypertension and diabetes, renal dysfunction, receiving surgery/chemotherapy, anemia and hypoalbuminemia were screened out as the major risk factors of EAD. In-hospital mortality in patients with EAD was 2.1% as compared to those with normal electrolytes (0.3%). The risk of death significantly increased among patients with severe EAD. Similarly, the length of stay and hospital cost also tripled as the number and grade of EAD increased. Conclusion: EAD is commonly encountered in cancer patients and associated with an ominous prognosis. Patients with comorbidities, renal/liver dysfunction, and anti-tumor therapy have a higher risk of EAD. Regular monitoring of electrolytes, optimum regimen for intravenous infusion, timely correction of modifiable factors and appropriate management of EAD should not be neglected during anti-tumor treatment.

Electrolyte and renal disorders in patients with newly diagnosed glioblastoma

“…In this cohort of GBM patients, arterial hypertension, diabetes, a higher age, and a poor preoperative clinical status characterized the cohort of patients with hypochloremia. This observation is in line with previous studies, that also reported renal dysfunction, hypertension, and diabetes as risk factors for electrolyte disorders (8).…”

“…In cancer patients, electrolyte and acid-base disorders are reported in more than 50% (8). Moreover, kidney function and electrolyte homeostasis have been linked to patients' prognosis for several types of cancer (8,10,11). This study identi ed hypochloremia in GBM as an independent prognostic marker for 1-YS and OS, whereas all other investigated electrolytes and parameters of kidney function failed to display a consistent relation to patients' outcome.…”

“…In 25,881 patients, hypochloremia occurred in 24.5% of patients. The authors found a higher in-hospital mortality in patients with electrolyte disorders compared to patients with normal electrolytes (8). In another investigation among 5,089 patients with colorectal cancer, hypochloremia was associated with a worse overall survival and shorter disease-free survival (9).…”

“…In cancer patients, electrolyte and acid-base disorders are reported in more than 50% (8). Moreover, kidney function and electrolyte homeostasis have been linked to patients' prognosis for several types of cancer (8,10,11).…”

“…Aberrations in serum electrolyte levels were shown to be associated with a higher mortality in intensive care units in critically ill adult patients (6,7). Several recent studies additionally suggest that electrolyte disorders might be associated with a worse prognosis in a variety of malignancies (8), e.g. in colorectal cancer (9), lung cancer (10) and lymphoma (11,12).…”