Preoperative hyponatremia in women with ovarian cancer: An additional cause for concern?

Abstract

Objective To determine if preoperative hyponatremia in women with ovarian, fallopian tube (FT), and primary peritoneal cancers (PPC) is associated with postoperative complications. Methods We performed a retrospective population-based cohort study of women with a postoperative diagnosis of ovarian, FT, or PPC who had a cytoreductive procedure in the National Surgical Quality Improvement Program (NSQIP) database from 2005-2013. The primary exposure, preoperative sodium, was classified as normal (135mEq/L - 142mEq/L) or hyponatremic (≤134mEq/L). Where appropriate, preoperative characteristics were compared with Chi-squared or Fisher’s exact tests. Multivariate logistic regression was used to determine adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results 4009 subjects met inclusion criteria. Thirty day mortality was higher in the hyponatremic group compared to the normal serum sodium group (3.56% vs 1.18%). When patients of any age were noted to have at least two pertinent preoperative lab abnormalities, including hyponatremia, there was an increased risk of postoperative complications for patients over the age of 65. After adjusting for serum albumin and other confounders, preoperative hyponatremia was associated with an increased risk of hospital stay of >14 days (aOR 1.69; 95% CI 1.11-2.57) and 30 day postoperative mortality (aOR 2.37; 95% CI 1.13-4.98). Conclusions Hyponatremia is associated with postoperative 30 day mortality and morbidity in women with ovarian, FT, and PPC. Serum sodium in conjunction with other markers may have the potential to identify candidates for neoadjuvant chemotherapy. Additional work is needed to determine if correction of hyponatremia in the preoperative period alters outcomes.

Prognostic and predictive role of hyponatremia in cancer patients

“…In addition, each mmol/L reduction of serum [Na + ] increased the risk of death by 2.3% [3] . Among different clinical settings, hyponatremia has been associated with an increased risk of death in patients with heart failure [4][5][6] , acute myocardial infarction [7,8] , pneumonia [9] , cirrhosis [10,11] , renal failure [12] , pulmonary embolism [13] , intracerebral hemorrhage [14] , in the elderly [15] , in intensive care patients [16] , in patients undergoing surgery [17] or cardiovascular procedures [18] . An extensive meta-analysis, including more than 850,000 patients, of whom 17.4% with hyponatremia, confirmed an increased mortality rate associated with reduced serum [Na + ] [19] .…”

Prognostic value of preoperative hyponatremia in patients with epithelial ovarian cancer

“…However, notably, the prevalence of EOC in these two studies was completely different. The prevalence of hyponatremia was 58.3% (28/48) in a study by Abu and coworkers 16, compared with 10.02% in a study by Martin and colleagues 11. This difference might be partly attributed to the different cut-off values used in the studies.…”

“…The severity of hyponatremia was found to be an independent factor predicting significantly higher in-hospital mortality 16. Subsequently, Martin and colleagues 11 performed a retrospective population-based cohort study of women with a postoperative diagnosis of ovarian, fallopian tube, or primary peritoneal cancer who had undergone a cytoreductive procedure in the National Surgical Quality Improvement Program database from 2005 to 2013. Unfavorable prognosis of postoperative 30-day mortality and morbidity was observed among patients with hyponatremia compared with patients with normal sodium levels 11.…”

“…Subsequently, Martin and colleagues 11 performed a retrospective population-based cohort study of women with a postoperative diagnosis of ovarian, fallopian tube, or primary peritoneal cancer who had undergone a cytoreductive procedure in the National Surgical Quality Improvement Program database from 2005 to 2013. Unfavorable prognosis of postoperative 30-day mortality and morbidity was observed among patients with hyponatremia compared with patients with normal sodium levels 11. Although we focused on the relatively long-term outcome, the direction of the association was consistent with these published studies.…”

“…To our knowledge, few studies have been performed to examine the prevalence and prognostic value of hyponatremia in EOC. The most recent study performed by Martin and colleagues 11 investigated the relationship between preoperative hyponatremia and the prognosis of women with ovarian, fallopian tube, and primary peritoneal cancers using the American College of Surgeons National Surgical Quality Improvement Program database, and observed a prevalence of 10.02% (365/3644) and a positive association between preoperative hyponatremia and lengthening of hospital stays, 30-day postoperative mortality rates, and postoperative complications 11. Nevertheless, whether preoperative hyponatremia may serve as a prognostic marker for EOC progression and long-term survival remains elusive.…”