Mortality after Hospitalization with Mild, Moderate, and Severe Hyponatremia - 12/08/11
, David B. Mount, MD a, b, Gary C. Curhan, MD, ScD a
Requests for reprints should be addressed to Sushrut S. Waikar, MD, MPH, Renal Division, Brigham and Women's Hospital, MRB-4, 75 Francis Street, Boston, MA 02115Abstract |
Background |
Hyponatremia is the most common electrolyte abnormality in hospitalized individuals.
Methods |
To investigate the association between serum sodium concentration and mortality, we conducted a prospective cohort study of 98,411 adults hospitalized between 2000 and 2003 at 2 teaching hospitals in Boston, Massachusetts. The main outcome measures were in-hospital, 1-year, and 5-year mortality. Multivariable logistic regression and Cox proportional hazards models were used to compare outcomes in patients with varying degrees of hyponatremia against those with normal serum sodium concentration.
Results |
Hyponatremia (serum sodium concentration <135 mEq/L) was observed in 14.5% of patients on initial measurement. Compared with patients with normonatremia (135-144 mEq/L), those with hyponatremia were older (67.0 vs 63.1 years, P <.001) and had more comorbid conditions (mean Deyo-Charlson Index 1.9 vs 1.4, P <.001). In multivariable-adjusted models, patients with hyponatremia had an increased risk of death in hospital (odds ratio 1.47, 95% confidence interval [CI], 1.33-1.62), at 1 year (hazard ratio 1.38, 95% CI, 1.32-1.46), and at 5 years (hazard ratio 1.25, 95% CI, 1.21-1.30). The increased risk of death was evident even in those with mild hyponatremia (130-134 mEq/L; odds ratio 1.37, 95% CI, 1.23-1.52). The relationship between hyponatremia and mortality was pronounced in patients admitted with cardiovascular disease, metastatic cancer, and those admitted for procedures related to the musculoskeletal system. Resolution of hyponatremia during hospitalization attenuated the increased mortality risk conferred by hyponatremia.
Conclusion |
Hyponatremia, even when mild, is associated with increased mortality.
Le texte complet de cet article est disponible en PDF.Keywords : Epidemiology, Hospitalization, Hyponatremia, Mortality, Outcomes
Plan
| Funding: Investigator-initiated grant from Astellas Pharma US, Inc. |
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| Conflict of Interest: Dr. Mount reported receiving lecture fees from Astellas Pharma, US, Inc. Astellas had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. |
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| Authorship: Dr. Waikar had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. |
Vol 122 - N° 9
P. 857-865 - septembre 2009 Retour au numéro
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