Fluctuations in serum sodium level are associated with an increased risk of death in surgical ICU patients

Sakr, Yasser; Rother, Sara; Ferreira, A; Ewald, Christian; Dünich, P; Reinhart, Konrad

doi:10.1186/cc10752

Cited by 20 publications

(35 citation statements)

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“…In several studies in patients admitted to wards or the ICU, dysnatremia was associated with excess mortality after adjustment for illness severity or case mix (2,3,5,6,13,15). In keeping with these findings, dysnatremia was both common and associated with higher day 28 mortality in our study.…”

Section: Discussionsupporting

confidence: 90%

“…Recent studies demonstrated that dysnatremia was a common abnormality associated with decreased survival (2,3,5,6,13,15). OR indicates odds ratio; 95% CI, 95% confidence interval; SOFA, Sequential Organ Failure Assessment, which can range from 0 to 24. dysnatremia.…”

Section: Discussionmentioning

confidence: 99%

“…Although previous studies consistently found an association between dysnatremia and mortality, there is no evidence to date for a causal relationship between these two events (2,13,15). Biological arguments confer plausibility to the dysnatremiamortality association, but the available data come from cohort studies that did not evaluate the clinical consequences of dysnatremia (2,3,5,6,13,15).…”

Section: Discussionmentioning

confidence: 99%

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Influence of Early Dysnatremia Correction on Survival of Critically Ill Patients

Darmon¹,

Pichon²,

Schwebel³

et al. 2014

Shock

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Increasing evidence suggests that dysnatremia at intensive care unit (ICU) admission may predict mortality. Little information is available, however, on the potential effect of dysnatremia correction. This is an observational multicenter cohort study in patients admitted between 2005 and 2012 to 18 French ICUs. Hyponatremia and hypernatremia were defined as serum sodium concentration less than 135 and more than 145 mmol/L, respectively. We assessed the influence on day 28 mortality of dysnatremia correction by day 3 and of the dysnatremia correction rate. Of 7,067 included patients, 1,830 (25.9%) had hyponatremia and 634 (9.0%) had hypernatremia at ICU admission (day 1). By day 3, hyponatremia had been corrected in 1,019 (1,019/1,830; 55.7%) and hypernatremia in 393 (393/634; 62.0%) patients. After adjustment for confounders, persistent hyponatremia or hypernatremia on day 3 was independently associated with higher day 28 mortality (odds ratio [OR], 1.31; 95% confidence interval [95% CI], 1.06 Y 1.61; and OR, 1.86; 95% CI, 1.37 Y 2.54; respectively). Hyponatremia corrected by day 3, hypernatremia corrected by day 3, and ICU-acquired hyponatremia were not associated with day 28 mortality. Median correction rate from days 1 to 3 was 2.58 mmol/L per day (interquartile range, 0.67 Y 4.55). Higher natremia correction rate was associated with lower crude and adjusted day 28 mortality rates (OR per mmol/L per day, 0.97; 95% CI, 0.94 Y 1.00; P = 0.04; and OR per mmol/L per day, 0.93; 95% CI, 0.90 Y 0.97; P = 0.0003, respectively). Our results indicate that dysnatremia correction is independently associated with survival, with the effect being greater with faster correction rates of up to 12 mmol/L per day.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of Early Dysnatremia Correction on Survival of Critically Ill Patients

Darmon¹,

Pichon²,

Schwebel³

et al. 2014

Shock

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“…Higher mortality associated with hyponatremia has been published among adult surgical intensive care patients, 17 among children awaiting liver transplant, 4 and among hospitalized cancer patients. 2 Al-Zahraa Omar et al 1 showed that hyponatremia was associated with longer hospital stay and worse neurological outcomes among children with various neurological diseases.…”

Section: Discussionmentioning

confidence: 99%

The incidence of postoperative hyponatremia and associated neurological sequelae in children with intracranial neoplasms

Williams

Belzer

Riva-Cambrin³

et al. 2014

PED

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Object Intracranial tumors are common pediatric neoplasms and account for substantial morbidity among children with cancer. Hyponatremia is a known complication of neurosurgical procedures and is associated with higher morbidity among neurosurgical patients. The authors aimed to estimate the incidence of hyponatremia, identify clinical characteristics associated with hyponatremia, and assess the association between hyponatremia and patient outcome among children undergoing surgery for intracranial tumors. Methods This is a retrospective cohort study of children ranging in age from 0 to 19 years who underwent an initial neurosurgical procedure for an intracranial tumor between January 2001 and February 2012. Hyponatremia was defined as serum sodium ≤ 130 mEq/L during admission. Results Hyponatremia during admission occurred in 39 (12%) of 319 patients and was associated with young age and obstructive hydrocephalus (relative risk [RR] 2.9 [95% CI 1.3–6.3]). Hyponatremic patients were frequently symptomatic; 21% had seizures and 41% had altered mental status. Hyponatremia was associated with complicated care including mechanical ventilation (RR 4.4 [95% CI 2.5–7.9]), physical therapy (RR 4 [95% CI 1.8–8.8]), supplemental nutrition (RR 5.7 [95% CI 3.3–9.8]), and infection (RR 5.7 [95% CI 3.3–9.5]). Hyponatremic patients had a 5-fold increased risk of moderate or severe disability on the basis of their Pediatric Cerebral Performance Category score at discharge (RR 5.3 [95% CI 2.9–9.8]). Obstructive hydrocephalus (adjusted odds ratio [aOR] 3.24 [95% CI 1.38–8.94]) and young age (aOR 0.92 [95% CI 0.85–0.99]) were independently associated with hyponatremia during admission. Hyponatremia was independently associated with moderate or worse disability by Pediatric Cerebral Performance Category score at discharge (aOR 6.2 [95% CI 3.0–13.03]). Conclusions Hyponatremia was common, particularly among younger children and those with hydrocephalus. Hyponatremia was frequently symptomatic and was associated with more complicated hospital courses. Hyponatremia was independently associated with worse neurological outcome when adjusted for age and tumor factors. This study serves as an exploratory analysis identifying important risk factors for hyponatremia and associated sequelae. Further research into the causes of hyponatremia and the association with poor outcome is needed to determine if prevention and treatment of hyponatremia can improve outcomes in these children.

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“…However, hyponatremia has been associated with worsened morbidity and mortality in a variety of adult and pediatric populations. Among adult patients, hyponatremia is associated with increased mortality in adult surgical intensive care patients, 24 increased complications among patients with heart failure, 3 and worse Glasgow Outcome Scale score following subarachnoid hemorrhage 25 and traumatic brain injury. 20 Among pediatric populations, hyponatremia is associated with increased mortality among liver transplant patients 5 and in children with pneumococcal meningitis.…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia and poor cognitive outcome following pediatric brain tumor surgery

Williams

Riva-Cambrin²,

Presson³

et al. 2015

PED

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OBJECT Pediatric intracranial neoplasms are common and cause substantial neurological morbidity. Postoperative hyponatremia is also common and may exacerbate neurological injury. The authors performed an exploratory analysis to evaluate an exposure-response relationship between hyponatremia severity and cognitive function at discharge. METHODS A retrospective cohort of patients 0–19 years old who underwent a first intracranial neoplasm surgery at a pediatric tertiary care hospital was reviewed. Outcome was assessed by Pediatric Cerebral Performance Category (PCPC) score of 1–6 at hospital discharge. Poor outcome was defined as PCPC score 3–6, corresponding to moderate or worse disability. RESULTS Of 319 total children, 80 (25%) had poor outcomes. One hundred thirty-seven children (43%) had serum sodium concentrations ≤ 131–135 mEq/L and 39 (12%) had serum sodium concentrations ≤ 130 mEq/L. Lower nadir sodium concentration and longer duration of hyponatremia were significantly associated with worsening PCPC score (p < 0.001). Rapid sodium decreases and more hyponatremic episodes were also significantly associated with worsening PCPC score (p < 0.001). After adjustment for patient factors, tumor characteristics, and measures of sodium disruption, multivariable analysis revealed noncortical tumor locations and lower nadir sodium concentration (adjusted odds ratio 0.86, 95% confidence interval 0.78–0.95) were important independent risk factors for poor cognitive outcome. CONCLUSIONS Neurocognitive disability and hyponatremia are common in children undergoing surgery for intracranial neoplasms. This study found a significant association between severity of hyponatremia and worsened cognitive outcome, with an apparent exposure-response relationship. These data support the need for careful postoperative monitoring of serum sodium. Further research is needed to determine if prevention and treatment of hyponatremia can improve outcomes in these children.

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Fluctuations in serum sodium level are associated with an increased risk of death in surgical ICU patients

Cited by 20 publications

References 0 publications

Influence of Early Dysnatremia Correction on Survival of Critically Ill Patients

Influence of Early Dysnatremia Correction on Survival of Critically Ill Patients

The incidence of postoperative hyponatremia and associated neurological sequelae in children with intracranial neoplasms

Hyponatremia and poor cognitive outcome following pediatric brain tumor surgery

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