Influence of Early Dysnatremia Correction on Survival of Critically Ill Patients

Abstract

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.

Dysnatrémie : faut-il y prêter attention ?

“…Ces données ont été confirmées récemment chez les patients de réanimation [5][6][7][28][29][30][31][32][33], de chirurgie [34][35][36], brulés [37] ou de médecine [38,39]. Ces études ont confirmé l'impact pronostique délé-tère aussi bien des hyponatrémies que des hypernatrémies, qu'elles soient acquises au cours du séjour ou présentes dès l'admission.…”

“…2) [5][6][7]. Pour les dysnatrémies pré-sentes à l'admission en réanimation, leur correction dans les trois premiers jours était associée à un meilleur pronostic [29]. La vitesse de correction semblait également associée au pronostic [29].…”

“…Pour les dysnatrémies pré-sentes à l'admission en réanimation, leur correction dans les trois premiers jours était associée à un meilleur pronostic [29]. La vitesse de correction semblait également associée au pronostic [29]. L'impact pronostique des dysnatrémies ne peut cependant être expliqué par leurs conséquences neurologiques.…”

The Reduction Rate of Serum Sodium and Mortality in Patients Undergoing Continuous Venovenous Hemofiltration for Acute Severe Hypernatremia

“…Hypernatremia is typically regarded as both a marker of disease severity and as an independent risk factor for intensive care unit (ICU) mortality (1,3,4,(11)(12)(13).…”

Hyponatremia in solid-tumor cancer patients: uncertainty regarding the use of vaptans

“…It is unknown whether correcting hyponatremia has an effect on the prognosis for cancer patients. However, Darmon et al studied an unselected population of patients hospitalized in intensive care and showed that, after controlling for confounding, persistent hyponatremia on day 3 was independently associated with a higher day-28 mortality (odds ratio [OR] 1.31; 95 % confidence interval [95 % CI], 1.06-1.61) [7]. Mild chronic hyponatremia, defined as a persistent (>72 h) plasma sodium concentration of between 125 and 135 mmol/L without apparent symptoms, is common in ambulatory patients and is generally perceived as inconsequential.…”