Prognostic Importance of Hyponatremia in Patients with Acute Pulmonary Embolism

Abstract

Rationale: Although associated with adverse outcomes in other cardiopulmonary conditions, the prognostic value of hyponatremia, a marker of neurohormonal activation, in patients with acute pulmonary embolism (PE) is unknown. Objectives: To examine the associations between hyponatremia and mortality and hospital readmission rates for patients hospitalized with PE. Methods: We evaluated 13,728 patient discharges with a primary diagnosis of PE from 185 hospitals in Pennsylvania (January 2000 to November 2002). We used random-intercept logistic regression to assess the independent association between serum sodium levels at the time of presentation and mortality and hospital readmission within 30 days, adjusting for patient (race, insurance, severity of illness, use of thrombolytic therapy) and hospital factors (region, size, teaching status). Measurements and Main Results: Hyponatremia (sodium <135 mmol/L) was present in 2,907 patients (21.1%). Patients with a sodium level greater than 135, 130-135, and less than 130 mmol/L had a cumulative 30-day mortality of 8.0, 13.6, and 28.5% (P , 0.001), and a readmission rate of 11.8, 15.6, and 19.3% (P , 0.001), respectively. Compared with patients with a sodium greater than 135 mmol/L, the adjusted odds of dying were significantly greater for patients with a sodium 130-135 mmol/L (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.33-1.76) and a sodium less than 130 mmol/L (OR, 3.26; 95% CI, 2.48-4.29). The adjusted odds of readmission were also increased for patients with a sodium of 130-135 mmol/L (OR, 1.28; 95% CI, 1.12-1.46) and a sodium less than 130 mmol/L (OR, 1.44; 95% CI, 1.02-2.02). Conclusions: Hyponatremia is common in patients presenting with PE, and is an independent predictor of short-term mortality and hospital readmission.

Prognostic Impact of the Charlson Comorbidity Index on Mortality following Acute Pulmonary Embolism

“…These include age, hyperlipidemia and serum hemoglobin. The current study not only confirms the acute prognostic importance of serum sodium in patients with acute PE [23], it also identifies that serum sodium during the index PE admission has important long-term prognostic influence for these patients. For every 1 mmol/l higher level of serum sodium on admission, there was a 3% lower risk for all-cause long-term mortality.…”

“…Hyponatremia is associated with adverse prognosis following acute coronary syndrome [19], patients with chronic heart failure [20], chronic renal failure on hemodialysis [21], and others [22]. Scherz et al [23] recently reported baseline hyponatremia to be a common phenomenon amongst patients presenting with acute PE and was an independent predictor of 30-day mortality. Including this easily obtainable biochemical parameter to the CCI score gave rise to a risk model that predicted in-hospital death with good discriminatory power (c statistic of 0.74, 95% CI 0.63-0.85; p < 0.0001).…”

Evaluation of incremental healthcare resource burden and readmission rates associated with hospitalized hyponatremic patients in the US

“…The only published study to date on the influence of hyponatremia on readmission rates in the real-world was conducted by Scherz et al, who reported that the co-occurrence of hyponatremia in patients with acute pulmonary embolism, discharged from 185 hospitals in Pennsylvania, was independently associated with an increased readmission rate of 19.3%. 27 In the present study, hyponatremia was associated with an incremental increase ranging between 14% and 17% for hospital readmission for any cause. It was conducted on a patient population in which hyponatremia was resultant from many causes, and not all patients had a serious comorbid condition.…”

Clinical Characteristics and Outcomes of Patients with Clinically Unsuspected Pulmonary Embolism versus Patients with Clinically Suspected Pulmonary Embolism

“…We found small but significant differences in laboratory parameters previously associated with morbidity in PE [12,13]. Patients with UPE had a slightly higher blood creatinine at PE diagnosis (1.16 ± 0.93 vs. 1.017± 0.44, respectively, p = 0.0341) and lower hemoglobin (11.7 ± 2.49 vs. 12.3 ± 1.75, respectively, p = 0.0089).…”