Impact of hyponatremia on mortality and morbidity in patients with COPD exacerbations

Abstract

Hyponatremia is the most common electrolyte disorder in hospitalized patients, being associated with increased morbidity and mortality in different clinical conditions. However, the prevalence and impact of this electrolytic disorder in patients hospitalized for an exacerbation of COPD still remains unknown. The aim of the present study was to clarify these points. A total of 424 patients hospitalized due to a COPD exacerbation were consecutively included, showing a frequency of hyponatremia of 15.8% (hyposmolar in most cases). Even though patients with and without hyponatremia showed a similar age, comorbidities, lung function impairment, presence of previous exacerbations, hospitalizations, most of the comorbidities and the overall severity index (APACHE II), their clinical outcomes were worse. Indeed, their hospitalization length, mechanical ventilation requirements and deaths (both during admission and within the months following discharge) were higher than those of non-hyponatremic patients. A sodium threshold lower than 129.7 mEq/L exhibited the better discriminatory power for death prediction. We conclude that hyponatremia (especially if severe) is a predictive marker for a bad clinical course in COPD exacerbations and therefore, patients with this electrolyte abnormality should be carefully monitored.

Symptomatic life-threating hyponatremia complicating severe COPD exacerbation, pulmonary edema and pulmonary hypertension-a critical role for conivaptan

“…We have presented in generally great detail, the diagnostic and therapeutic complexities involved in the management of hyponatremia especially when this is complicated by co-existing pulmonary edema, acutely decompensating heart failure and pulmonary hypertension in the context of advanced COPD. We were able to achieve excellent 'diuresis' using the aquaresis-inducing properties of intravenous conivaptan, an ADH antagonist (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Notedly, dyspnea, edema and volume overload promptly resolved as confirmed by follow up symptomatic relief, resolution of physical examination findings and improvement evident in the follow up chest radiograph (Figure 1).…”

“…Finally, treatment with intravenous conivaptan facilitated improvement of severe symptomatic hyponatremia in our patient, and simultaneously, the resulting aquaresis led to a rapid and sustained improvement in his dyspnea from pulmonary edema. There is accruing evidence in the literature that the vaptans, intravenous conivaptan and oral tolvaptan, have now earned a place in the therapeutic armamentarium to manage symptomatic acutely decompensating heart failure complicated by severe hyponatremia and volume overload (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Subsequently, the administration of loop diuretics appears to be usually well tolerated without necessarily a need for the prolonged use of the vaptans.…”

“…Hyponatremia is the most common electrolyte abnormality in hospitalized patients and is associated with increased morbidity and mortality (1)(2)(3)(4)(5)(6). Furthermore, experience from phase three trials and subsequent studies including the Study of Ascending Levels of Tolvaptan in Hyponatremia 1 and 2 (SALT 1 and 2), clearly demonstrated that the efficacy of vasopressin antagonists in increasing the plasma sodium level is unquestionable (1)(2)(3)(4).…”

“…As recently as 2015, there existed conflicting recommendations for the use of vaptans by different expert committees in patients with hyponatremia and this was blamed on limited patient experiences and limited research data (7). Nevertheless, there is now accumulating evidence-base in the literature to strongly support the use of the vaptans in the management of severe symptomatic treatment-resistant hyponatremia especially in association with heart failure, advanced chronic obstructive pulmonary disease (COPD) and/or pulmonary hypertension (6,(8)(9)(10)(11). Vasopressin antagonists block the vasopressin receptors V1 and V2.…”

Survival and Mortality of Patients with Hyponatremia in Intensive Care Units: A Retrospective Study of 327 Patients Hospitalized at Sylvanus Olympio University Hospital

“…We found 28.6% of neurological pathologies, 20.2% of renal pathologies and 5.1% of cardiac pathologies. Several authors have reported that diseases of the central nervous system constitute the main etiologies of hyponatremia [15,16]. This is explained by the alteration of the tubular reabsorption of sodium which is manifest during a cerebral lesion thus decreasing the sodic pool of the organism [15].…”