Epidemiology, clinical and economic outcomes of admission hyponatremia among hospitalized patients

Zilberberg, Marya D.; Exuzides, Alex; Spalding, James; Foreman, Aimee J.; Jones, Alison Graves; Colby, Chris; Shorr, Andrew F.

doi:10.1185/03007990802081675

Cited by 152 publications

(141 citation statements)

References 19 publications

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“…As indicated by the divergent results of previous studies, the prevalence of hyponatremia is highly influenced by study population composition (4,12), criteria applied to define hyponatremia at hospital admission (3,4), and composition of the denominator (i.e. whether only patients for whom serum sodium was measured were included) (3,4,6,12). The 15% overall prevalence of hyponatremia observed in our study is comparable with that observed among 2171 internal medicine patients in a recent single-center study (5).…”

Section: European Journal Of Endocrinologysupporting

confidence: 73%

“…Mortality risk was increased across virtually all major primary discharge diagnosis groups and categories of previous morbidity. As indicated by the divergent results of previous studies, the prevalence of hyponatremia is highly influenced by study population composition (4,12), criteria applied to define hyponatremia at hospital admission (3,4), and composition of the denominator (i.e. whether only patients for whom serum sodium was measured were included) (3,4,6,12).…”

Section: European Journal Of Endocrinologymentioning

confidence: 97%

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Hyponatremia and mortality risk: a Danish cohort study of 279 508 acutely hospitalized patients

Holland-Bill¹,

Christiansen²,

Heide-Jørgensen³

et al. 2015

European Journal of Endocrinology

122

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Objective: We aimed to investigate the impact of hyponatremia severity on mortality risk and assess any evidence of a dose-response relation, utilizing prospectively collected data from population-based registries. Design: Cohort study of 279 508 first-time acute admissions to Departments of Internal Medicine in the North and Central Denmark Regions from 2006 to 2011. Methods: We used the Kaplan-Meier method (1 -survival function) to compute 30-day and 1-year mortality in patients with normonatremia and categories of increasing hyponatremia severity. Relative risks (RRs) with 95% CIs, adjusted for age, gender and previous morbidities, and stratified by clinical subgroups were estimated by the pseudo-value approach. The probability of death was estimated treating serum sodium as a continuous variable. Results: The prevalence of admission hyponatremia was 15% (41 803 patients). Thirty-day mortality was 3.6% in normonatremic patients compared to 7.3, 10.0, 10.4 and 9.6% in patients with serum sodium levels of 130-134.9, 125-129.9, 120-124.9 and !120 mmol/l, resulting in adjusted RRs of 1.4 (95% CI: 1.3-1.4), 1.7 (95% CI: 1.6-1.8), 1.7 (95% CI: 1.4-1.9) and 1.3 (95% CI: 1.1-1.5) respectively. Mortality risk was increased across virtually all clinical subgroups, and remained increased by 30-40% 1 year after admission. The probability of death increased when serum sodium decreased from 139 to 132 mmol/l. No clear increase in mortality was observed for lower concentrations. Conclusions: Hyponatremia is highly prevalent among patients admitted to Departments of Internal Medicine and is associated with increased 30-day and 1-year mortality risk, regardless of underlying disease. This risk seems independent of hyponatremia severity.

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Section: European Journal Of Endocrinologysupporting

confidence: 73%

Section: European Journal Of Endocrinologymentioning

confidence: 97%

Hyponatremia and mortality risk: a Danish cohort study of 279 508 acutely hospitalized patients

Holland-Bill¹,

Christiansen²,

Heide-Jørgensen³

et al. 2015

European Journal of Endocrinology

122

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“…The results of this study are consistent with others in showing that HN patients use healthcare services more extensively, and represent a patient population which is more expensive to treat in the inpatient setting. 5,22 Additionally, this study yields new findings in that patients in the real-world with hyponatremia resulting from various etiologies are more likely to be readmitted to the hospital than patients with similar demographics and characteristics who do not have hyponatremia. The results of the subgroup analysis were generally consistent with the results for the overall matched population, as the incremental burden estimates were directionally consistent.…”

Section: Discussionmentioning

confidence: 79%

“…Zilberberg et al and Callahan et al additionally reported that HN patients had a significantly greater need for ICU (4%-10%). 5,22 In the present study, LOS in the ICU and associated costs were also compared among HN and non-HN cohorts and, after adjustment for key patient characteristics, hyponatremia was associated with an incremental increase of 10.2% for ICU LOS and an 8.9% increase in ICU cost.…”

Section: Discussionmentioning

confidence: 89%

“…The incidence of hyponatremia in the general hospitalized population has been reported to range between 1% and 6% when defined as <130-135 mEq/L, 4,5 and its occurrence increases with a more prolonged hospital stay to 13%. 6 A recent study reported that when hyponatremia was defined with a less stringent threshold of <138 mEq/L, the incidence at admission rose to 38%.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of incremental healthcare resource burden and readmission rates associated with hospitalized hyponatremic patients in the US

Amin

Deitelzweig

Christian

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:Hyponatremia is a prevalent electrolyte disorder in hospitalized patients indicative of greater morbidity and mortality. A large‐scale retrospective analysis was conducted to evaluate the incremental burden of hospitalized hyponatremic (HN) versus non‐HN patients in terms of hospital resource utilization, costs, and hospital readmissions in the real‐world setting.METHODS:HN patients (≥18 years) were selected from the Premier Hospital Database between January 1, 2007 and March 31, 2010 and matched to a non‐HN control cohort using propensity score matching. Bivariate and multivariate statistics were employed to evaluate the differences in healthcare resource utilization, costs, and hospital readmissions between patient cohorts.RESULTS:Among the matched patient cohorts, length of stay (LOS) (8.8 ± 10.3 vs 7.7 ± 8.5 days, P < 0.001), hospital admission costs ($15,281 ± $24,054 vs $13,439 ± $22,198, P < 0.001), intensive care unit (ICU) LOS (5.5 ± 7.9 vs 4.9 ± 7.1 days, P < 0.001), and ICU costs ($8525 ± $13,342 vs $7597 ± $12,695, P < 0.001) were greater for the HN versus non‐HN cohort, as were hospital readmission rates 30 days postdischarge. Multivariate regressions further demonstrated that hyponatremia was associated with an increase of 10.9% for LOS, 8.2% for total hospitalization costs, 10.2% for ICU LOS, and 8.9% for ICU costs. Additionally, after multivariate adjustment, hyponatremia was associated with a 15.0% increased chance for hospital readmission 30 days postdischarge (P < 0.0001).CONCLUSIONS:Hyponatremia is an independent predictor of increased hospitalization LOS and cost, ICU admission and cost, and 30‐day hospital readmission, and therefore represents a potential target for intervention to reduce healthcare expenditures for a large population of hospitalized hyponatremic patients. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

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Preoperative Hyponatremia and Perioperative Complications

Leung¹,

McAlister²,

Rogers³

et al. 2012

Arch Intern Med

122

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Epidemiology, clinical and economic outcomes of admission hyponatremia among hospitalized patients

Cited by 152 publications

References 19 publications

Hyponatremia and mortality risk: a Danish cohort study of 279 508 acutely hospitalized patients

Hyponatremia and mortality risk: a Danish cohort study of 279 508 acutely hospitalized patients

Evaluation of incremental healthcare resource burden and readmission rates associated with hospitalized hyponatremic patients in the US

Preoperative Hyponatremia and Perioperative Complications

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