Hypernatremia predicts poor survival in patients with terminal cancer: a retrospective cohort study

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background:</jats:bold> Although palliative care providers, patients, and their familes rely heavily on accurate prognostication, the prognostic value of electrolyte imbalance has received little attention.<jats:bold>Methods:</jats:bold> As a retrospective review, we screened inpatients with terminal cancer admitted between January 2017 and May 2019 to one hospice-palliative care unit. Clinical characteristics and laboratory results were obtained from medical records for multivariable Cox regression analysis of independant prognostic factors.<jats:bold>Results: </jats:bold>Of the 487 patients who qualified, 15 (3%) were hypernatremic upon admission. Median survival time was 26 days. Parameters associated with shortened survival included male sex, advanced age (&gt; 70 years), lung cancer, poor performance status, elevated inflammatory markers, azotemia, impaired liver function, and hypernatermia. In a multivariable Cox proportional hazards model, male sex (hazard ratio [HR]=1.53, 95% confidence interval [CI]: 1.15–2.04), poor performance status (HR=1.45, 95% CI: 1.09–1.94), leukocytosis (HR=1.98, 95% CI: 1.47–2.66), hypoalbuminemia (HR=2.06, 95% CI: 1.49–2.73) and hypernatremia (HR=1.55, 95% CI: 1.18–2.03) emerged as significant predictors of poor prognosis.<jats:bold>Conclusion: </jats:bold>Hypernatremia may be a useful gauge of prognosis in patients with terminal cancer. Further corroborative studies of large scale and prospective design are needed.</jats:p>