Impact of Hyponatremia on COPD Exacerbation Prognosis

Abstract

The most common electrolyte disorder among hospitalized patients, hyponatremia is a predictor of poor prognosis in various diseases. The aim of this study was to establish the prevalence of hyponatremia in patients admitted for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), as well as its association with poor clinical progress. Prospective observational study carried out from 1 October 2016 to 1 October 2018 in the following hospitals: Salnés in Vilagarcía de Arousa, Arquitecto Marcide in Ferrol, and the University Hospital Complex of Santiago de Compostela, Galicia, Spain, on patients admitted for AECOPD. Patient baseline treatment was identified, including hyponatremia-inducing drugs. Poor progress was defined as follows: prolonged stay, death during hospitalization, or readmission within one month after the index episode discharge. 602 patients were enrolled, 65 cases of hyponatremia (10.8%) were recorded, all of a mild nature (mean 131.6; SD 2.67). Of all the patients, 362 (60%) showed poor progress: 18 (3%) died at admission; 327 (54.3%) had a prolonged stay; and 91 (15.1%) were readmitted within one month after discharge. Patients with hyponatremia had a more frequent history of atrial fibrillation (AF) (p 0.005), pleural effusion (p 0.01), and prolonged stay (p 0.01). The factors independently associated with poor progress were hyponatremia, pneumonia, and not receiving home O2 treatment prior to admission. Hyponatremia is relatively frequent in patients admitted for AECOPD, and it has important prognostic implications, even when mild in nature.

Hyponatremia is an independent predictor of emergency department revisits in acute exacerbation of COPD

“…However, higher frequency of anemia, pleural effusion, higher values of leukocytes, and CRP have been observed in patients with hyponatremia. 13 In line with the literature, the present study also found similar values regarding age, gender, LTOT, and NIV usage in patients with normonatremia and hyponatremia. CCI scores, leucocytes, neutrophils, AST, and CRP values were higher in hyponatremia whereas hemoglobin and lymphocytes were lower.…”

“…24 The classification of hyponatremia is reported as mostly mild and moderate. 13,24 In parallel to the literature, the rates of hyponatremia in home-manageable AECOPD was 22% in our study and most of these patients were classified as mild. Several parameters have been described to be related to hyponatremia.…”

“…Prolonged hospital stay was detected in 54.3% and in-hospital death in 3%, and readmission within one month after the discharge was recorded in 15.1% of the patients. 13 In the current study, readmission rates were found to be higher than those in the literature. There are three most probable reasons to explain this divergence with the literature.…”

“…12 Poor progress with prolonged hospital stay, in-hospital death, and readmission within 30 days were reported to be significantly higher in patients with hyponatremia. 13 In severe AECOPD requiring intensive care unit treatment, hyponatremia is demonstrated to be an independent predictor of mortality. 14 In contrast with these studies, other studies reported no correlation between baseline and discharge hyponatremia and readmission.…”

Factors Associated with Treatment Failure in Patients with Acute Exacerbation of COPD Admitted to the Emergency Department Observation Unit

“…Also, the data came from a single hospital and the results should not be generalized to other hospitals. Furthermore, other variable factors that may seem relevant to treatment failure, such as blood eosinophils, serum sodium, FEV1 <30% predicted, and treatment at discharge, were not obtained in this study [ 6 , 29 – 31 ].…”