Incidence and prognosis of dysnatraemia in critically ill patients: analysis of a large prevalence study

Vandergheynst, Frédéric; Sakr, Yasser; Felleiter, Peter; Hering, R.; Groeneveld, Johan; Vanhems, Philippe; Taccone, Fabio Silvio; Vincent, Jean‐Louis

doi:10.1111/eci.12123

Cited by 54 publications

(57 citation statements)

References 24 publications

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“…However, inducing hypernatraemia is the most common, safe and feasible means of achieving hyperosmolarity in the clinical setting. There have been concerns around the association of hypernatraemia and mortality in unselected cohort of patients . However, based on our results, previous animal studies and provided that the hypernatraemia is induced safely (i.e.…”

Section: Discussionmentioning

confidence: 56%

ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia

et al. 2017

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Section: Discussionmentioning

confidence: 56%

ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia

et al. 2017

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“…Dysnatremia can affect a number of physiological functions [5,6] and has been shown to negatively impact upon prognosis for patients in intensive care [2–4,7]. Both dysnatremia at admission and that acquired in the intensive care unit (ICU) have been shown to have a direct influence on prognosis [8]. Current studies have mostly been conducted in unselected general hospital populations and mixed ICU populations of both medical and surgical patients.…”

Section: Introductionmentioning

confidence: 99%

The association between sodium fluctuations and mortality in surgical patients requiring intensive care

Marshall

Salciccioli

Goodson

et al. 2017

Journal of Critical Care

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Purpose Serum sodium derangement is the most common electrolyte disturbance among patients admitted to intensive care. This study aims to validate the association between dysnatremia and serum sodium fluctuation with mortality in surgical intensive care patients. Method We performed a retrospective analysis of the Medical Information Mart for Intensive Care II database. Dysnatremia was defined as a sodium concentration outside physiologic range (135–145 mmol/L) and subjects were categorized by severity of dysnatremia and sodium fluctuation. Univariate and multivariable logistic regressions were used to test for associations between sodium fluctuations and mortality. Results We identified 8600 subjects, 39% of whom were female, with a median age of 66 years for analysis. Subjects with dysnatremia were more likely to be dead at 28 days (17% vs 7%; P < .001). There was a significant association between sodium fluctuation and mortality at 28 days (adjusted odds ratio per 1 mmol/L change, 1.10 [95% confidence interval, 1.08–1.12; P < .001]), even in patients who remained normotremic during their intensive care unit stay (1.12 [95% confidence interval, 1.09–1.16; P < .001]) Conclusions This observational study validates previous findings of an association between serum sodium fluctuations and mortality in surgical intensive care patients. This association was also present in subjects who remained normonatremic throughout their intensive care unit admission.

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“…A few studies have looked at the consequences of a high sodium level in hospitalised patients, typically in those admitted to intensive care units (ICU), finding significantly worse outcomes. This includes between a 1.5 -and 10-fold greater risk of dying, [12][13][14][15][16][17] increased risk of acute coronary events, pneumonia and thromboembolism, 18 worse outcomes of patients with cancer, 19 with chronic kidney disease 20 and stroke, 21 as well as of unselected admissions. 22 However, most of these studies have focused either on hypernatraemia arising during admission, increasingly viewed as a marker of quality of hospital or ICU care, or have not differentiated that present on admission from that arising later.…”

Section: Introductionmentioning

confidence: 99%

Are patients admitted to hospitals from care homes dehydrated? A retrospective analysis of hypernatraemia and in-hospital mortality

2015

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Objectives: To compare risks of hypernatraemia on admission to hospital in persons who were with those who were not identified as care home residents and evaluate the association of hypernatraemia with in-hospital mortality. Design: Retrospective observational study. Setting: A National Health Service Trust in London. Participants: A total of 21,610 patients aged over 65 years whose first admission to the Trust was between 1 January 2011 and 31 December 2013. Main outcome measures: Hypernatraemia on admission (plasma Na > 145 mmol/L) and in-hospital death. Results: Patients admitted from care homes had 10-fold higher prevalence of hypernatraemia than those from their own homes (12.0% versus 1.3%, respectively; odds ratio [OR]: 10.5, 95% confidence interval [CI]: 8.43-13.0). Of those with hypernatraemia, nine in 10 cases were associated with nursing home ECOHOST residency (attributable fraction exposure: 90.5%), and the population attributable fraction of hypernatraemia on admission associated with care homes was 36.0%. After correcting for age, gender, mode of admission and dementia, care home residents were significantly more likely to be admitted with hypernatraemia than were own-home residents (adjusted odds ratio [AOR]: 5.32, 95% CI: 3.85-7.37). Compared with own-home residents, care home residents were also at about a two-fold higher risk of in-hospital mortality compared with non-care home residents (AOR: 1.97, 95% CI: 1.59-2.45). Consistent with evidence that hypernatraemia is implicated in higher mortality, the association of nursing homes with in-hospital mortality was attenuated after adjustment for it (AOR: 1.61, 95% CI: 1.26-2.06). Conclusions: Patients admitted to hospital from care homes are commonly dehydrated on admission and, as a result, appear to experience significantly greater risks of inhospital mortality.

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Incidence and prognosis of dysnatraemia in critically ill patients: analysis of a large prevalence study

Abstract: Dysnatraemia is more frequent during the ICU stay than on the day of admission. Dysnatraemia in the ICU - even mild - is an independent predictor of increased hospital mortality.

Cited by 54 publications

References 24 publications

ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia

ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia

The association between sodium fluctuations and mortality in surgical patients requiring intensive care

Are patients admitted to hospitals from care homes dehydrated? A retrospective analysis of hypernatraemia and in-hospital mortality

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