Prognostic and predictive role of hyponatremia in cancer patients

Peri, Alessandro

doi:10.20517/2394-4722.2019.14

Cited by 5 publications

(8 citation statements)

References 44 publications

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“…The evolution of serum creatinine together with SNa is also a good parameter. Serum creatinine usually increases when natremia drops in the hypovolemic patient and usually decreases along with hyponatremia in the euvolemic patient [14] .…”

Section: Physical Examination Orthostatismmentioning

confidence: 99%

“…Additional treatments for hyponatremia must be avoided during the first 24 h of correction, except for associated furosemide in patients with heart failure or the addition of potassium chloride in patients with initial hypokalemia [2,14] [ Table 5] [22] .…”

Section: A Patient Who Is a Candidate For Chemotherapymentioning

confidence: 99%

“…In cancer patients with a high prevalence of and risk for malnutrition and the frequent need for dilution of chemotherapy, fluid restriction is often not viable [14,19] .…”

Section: Mild/moderate Hypervolemic or Euvolemic Hyponatremiamentioning

confidence: 99%

“…The impact of correction of hyponatremia on patient survival has yet to be ascertained. In some patient series, the correction of hyponatremia correlates with an improvement in quality of life and an improved prognosis [4,14] .…”

Section: Introductionmentioning

confidence: 99%

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The management of hyponatremia in cancer patients: a practical view in Spain

Marquina¹,

Gómez-Hoyos²,

Rünkle³

2020

JCMT

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Hyponatremia is a common disorder among cancer patients and is associated with a poor prognosis in several malignancies. It is classified by volemic status into hypovolemic, euvolemic, and hypervolemic hyponatremia. Clinical history, physical examination, and blood and urine tests are important for a correct classification and diagnosis of hyponatremia, to assure correct management. Treatment of hyponatremia in cancer patients depends on the etiology of hyponatremia, as well as on the chosen therapy for the tumor. Supportive care is also a factor to be taken into account.

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Section: Physical Examination Orthostatismmentioning

confidence: 99%

Section: A Patient Who Is a Candidate For Chemotherapymentioning

confidence: 99%

“…In cancer patients with a high prevalence of and risk for malnutrition and the frequent need for dilution of chemotherapy, fluid restriction is often not viable [14,19] .…”

Section: Mild/moderate Hypervolemic or Euvolemic Hyponatremiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The management of hyponatremia in cancer patients: a practical view in Spain

Marquina¹,

Gómez-Hoyos²,

Rünkle³

2020

JCMT

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“…Based on literature reports, hyponatremia and SIADH appear to be important negative predictive factors of mortality in numerous medical conditions, including lung cancer [4,9,12,[18][19][20][21][22], but not in every paper reached this conclusion [6,10]. However, a recent meta-analysis of fifteen studies confirmed the prognostic significance of serum sodium levels by demonstrating that the correction of hyponatremia is associated with reduced risk of mortality in hospitalized oncology patients [23].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Prognostic Significance of Hyponatremia in Lung Cancer Patients: Systematic Review and Meta-Analysis

Bartalis¹,

Gergics²,

Tinusz³

et al. 2020

Preprint

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Background The prevalence of hyponatremia is highly variable among lung cancer patients. It is also an important predictive factor, according to numerous studies. However, its prevalence and prognostic significance in subgroups of lung cancer patients, e.g. in small cell and non-small cell lung cancers (SCLC and NSCLC, respectively), have not yet been evaluated in a meta-analysis.Methods We report this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2009) Statement. We have registered our meta-analysis and review’s protocol to the PROSPERO International Prospective Register of Systematic Reviews, with the following registration number: CRD42020167013. A systematic search was done in the following sources: MEDLINE, Embase, CENTRAL, Web of Science, ClinicalTrials.gov, a WHO Global Health Library. We extracted the effect measure for each outcome as the relative risk (RR) with the related 95% confidence interval (CI). Results We identified a total of 8127 potentially eligible studies and we included 25 studies in our evaluation. The prevalence of hyponatremia in lung cancer patients varied between 3% and 56.1% with an average of 23% without any significant differences between the following subgroups: cancer type (p=0.780), gender (p=0.223), age (p=0.773), ECOG state (p=0.317) and the extent of disease (p=0.999). Hyponatremia was more consistently an independent prognostic factor in NSCLC than in SCLC. The overall survival (OS) was significantly lower in hyponatremic compared to normonatremic patients at 10 months (RR: 0.59, 95% CI, 0.47 to 0.74, p<0.001) and at 20 months (RR: 0.44, 95% CI, 0.33 to 0.59, p<0.001), with worse survival rates in NSCLC than in SCLC (27% vs 42%) (p<0.001). If hyponatremia was corrected, OS at 10 months was 1.83 times higher than in the uncorrected hyponatremia group (95% CI, 1.37 to 2.44, p<0.001), but at 20 months no statistically significant difference could be found between these subgroups (p=0.067).Conclusions Low serum sodium levels have a negative impact on mortality at 10 and 20 months, which is more pronounced among NSCLC patients. The correction of hyponatremia has a positive effect on OS rates at 10 months, but this advantage disappears by 20 months.

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Severe hyponatraemia in two patients with breast cancer caused by low-dose cyclophosphamide and precipitated by aprepitant

2022

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Two postmenopausal women with breast cancer developed acute confusion and seizures, less than 24 hours after the first cycle of neoadjuvant chemotherapy with fluorouracil, epirubicin and low-dose cyclophosphamide. They were found to have severe, life-threatening hyponatraemia with sodium levels of 113 and 115 mEq/L, respectively. Both women made a full recovery within 24 hours of admission with slow correction of sodium levels. Following investigational workup, the most likely diagnosis was cyclophosphamide-associated syndrome of inappropriate antidiuretic hormone secretion (SIADH). Aprepitant - a commonly used antiemetic and moderate cytochromeP450 3A4 inhibitor was identified as the precipitating factor. Aprepitant was discontinued and both women were successfully re-challenged with full dose cyclophosphamide in an outpatient setting with no subsequent adverse events. This is a typical case of a rare cause of a common medical problem. A systematic approach to diagnosis and treatment of hyponatraemia in an oncology patient requires awareness of toxicities of systemic anticancer agents.

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Prognostic and predictive role of hyponatremia in cancer patients

Cited by 5 publications

References 44 publications

The management of hyponatremia in cancer patients: a practical view in Spain

The management of hyponatremia in cancer patients: a practical view in Spain

Prevalence and Prognostic Significance of Hyponatremia in Lung Cancer Patients: Systematic Review and Meta-Analysis

Severe hyponatraemia in two patients with breast cancer caused by low-dose cyclophosphamide and precipitated by aprepitant

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