The prognosis of hyponatremia at hospital admission

Tierney, William M.; Martin, Douglas K.; Greenlee, M. Carol; Zerbe, Robert L.; McDonald, Clement J.

doi:10.1007/bf02596422

Cited by 116 publications

(72 citation statements)

References 10 publications

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“…In a recent study of middle-aged and elderly community subjects without a history of heart failure, hyponatremia was an independent predictor of death, regardless of concomitant diuretic use, renal and hepatic disease, and hyperglycemia (18). In large, retrospective and prospective cohort studies, hyponatremia also significantly increased short-term mortality in unselected inpatients (19)(20)(21)(22). Indeed, the relationship between hyponatremia and adverse outcomes is incompletely understood because of its association with a multitude of underlying disease states, and its multiple causes with different pathophysiologic mechanisms (23).…”

Section: Discussionmentioning

confidence: 95%

Prognostic Importance of Hyponatremia in Patients with Acute Pulmonary Embolism

Scherz¹,

Labarère²,

Méan³

et al. 2010

Am J Respir Crit Care Med

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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.

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Section: Discussionmentioning

confidence: 95%

Prognostic Importance of Hyponatremia in Patients with Acute Pulmonary Embolism

Scherz¹,

Labarère²,

Méan³

et al. 2010

Am J Respir Crit Care Med

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“…The most crucial causes of hyponatraemia in cancer patients are excessive secretion of vasopressin by tumour cells, which clinically manifests itself as the syndrome of inappropriate antidiuretic hormone secretion (SIADH) -the most frequent cause of normovolemic hyponatraemia -and sodium loss through various ways (mainly through the alimentary tract and the kidneys) in the course of primary disease or due to the conducted therapy. The above causes in equal parts account for 2/3 of all hyponatraemia cases connected with cancer [12].…”

Section: Discussionmentioning

confidence: 99%

“…It was noticed that hyponatraemia, regardless of cause, might be the factor that increases in-hospital and post-hospital mortality and prolongs hospitalization [2,4,12]. Even mild hyponatraemia influences the higher risk of in-hospital deaths [11].…”

Section: Discussionmentioning

confidence: 99%

Hyponatraemia—Evaluation of Prevalence in Patients Hospitalized in the Pulmonary Department and Prognostic Significance in Lung Cancer Patients

Zarzecka

Kubicki²,

Kozielski³

2013

Advances in Respiratory Medicine

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Introduction: It is known from clinical practice that data concerning plasma sodium concentration and its influence on patient prognosis are underestimated. The aim of this study was the evaluation of the prevalence and influence of hyponatraemia on prognosis in patients with lung diseases, particularly with lung cancer. Material and methods: Retrospective analysis of data obtained from a single Pulmonary Department was performed. A total of 449 patients divided in two groups, were analysed. The first group consisted of all lung cancer patients (n = 290) hospitalized in the analysed period. The second group included patients with hyponatraemia but without diagnosed lung cancer (n = 159). The prevalence of hyponatraemia, including severity (mild, moderate or severe), was evaluated. Histological types of lung cancer as well as comorbidities were taken into account. Results: Hyponatraemia was found in 46.9% of patients with lung cancer, including mild (serum sodium 135-130 mEq/L), moderate (129-125 mEq/L) and severe hyponatraemia (< 125 mEq/L) in 66.9%, 25% and 8.1, respectively. In patients without lung cancer and with recognized hyponatraemia, mild, moderate and severe hyponatraemia were found in 81.8%, 13.2% and 5%, respectively (mainly in obstructive and interstitial lung diseases). Hyponatraemia was observed in 52.6% of patients with non-small cell lung cancer (NSCLC) and in 45.2% of patients with small cell lung cancer (SCLC). There was no statistical significance in prevalence of hyponatraemia between histological types of lung cancer. In patients with lung cancer and hyponatraemia compared to patients with lung cancer but without hyponatraemia, a significant increase of in-hospital mortality was found (28.7% vs. 7.8%, respectively) p < 0.001. Conclusions: Hyponatraemia was a common abnormality found in approximately 50% of lung cancer patients. Hyponatraemia was a significant prognostic factor associated with poor prognosis.

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“…However, the significance of hyponatremia has been overlooked in clinical practice, and cases of mild chronic hyponatremia are generally considered benign (Decaux 2006). Recent studies have reported that hyponatremia is associated with a high mortality rate in various medical conditions (Baran and Hutchinson 1984;Tierney et al 1986;Gill et al 2006;Whelan et al 2009;Waikar et al 2009;Wald et al 2010). Hyponatremia is particularly prevalent in chronic liver disease and associated with a poor prognosis in patients with end stage liver disease waiting for a liver transplant (Angeli et al 2006;Kim et al 2008;Basto et al 2011).…”

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confidence: 99%

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

Lee

et al. 2013

Tohoku J. Exp. Med.

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Hyponatremia is prevalent before liver transplantation and generally corrected immediately after transplantation. However, the clinical significance of correction rate of hyponatremia is not well investigated. The prognostic impact of pre-transplant serum sodium concentrations and post-transplant correction rate of hyponatremia were assessed. A total of 512 patients who received orthotopic liver transplants were enrolled. The correction rate of hyponatremia (delta sodium, ΔNa) was calculated based on the data collected during the first 48 hours following liver transplantation. Outcomes, including in-hospital mortality, delirium, neurological complications, acute kidney injury, and infections, were compared according to the serum sodium levels (sNa < 125, 125-135, and ≥ 135 mmol/L), and the risk factors for in-hospital mortality and neurological complications were analyzed using multivariate logistic regression methods. Patients with severe hyponatremia (sNa < 125 mmol/L) had higher rates of in-hospital mortality (9.6%, P = 0.010), delirium (54.8%, P = 0.003), neurological complications (24.7%, P = 0.003), and acute kidney injury (57.5%, P = 0.005). In multivariate analysis, serum sodium levels (OR = 0.975, P = 0.402) and delta sodium (OR = 1.097, P = 0.066) were not independent risk factors for in-hospital mortality. However, delta sodium (OR = 1.093, P = 0.003) and fast correction rate of hyponatremia (ΔNa ≥ 12 mmol/ L/24h, OR = 3.397, P = 0.023) were significantly associated with post-transplant neurological complications. Pre-transplantation hyponatremia was not independently associated with clinical outcomes. However, rapid correction of hyponatremia is an independent risk factor for the development of post-transplant neurological complications.

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The prognosis of hyponatremia at hospital admission

Cited by 116 publications

References 10 publications

Prognostic Importance of Hyponatremia in Patients with Acute Pulmonary Embolism

Prognostic Importance of Hyponatremia in Patients with Acute Pulmonary Embolism

Hyponatraemia—Evaluation of Prevalence in Patients Hospitalized in the Pulmonary Department and Prognostic Significance in Lung Cancer Patients

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

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