Advertisement

Sodium levels on admission are associated with mortality risk in hospitalized patients

  • Amit Akirov
    Correspondence
    Corresponding author at: Institute of Endocrinology, Rabin Medical Center-Beilinson Hospital, Petach Tikva 49100, Israel.
    Affiliations
    Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel

    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • Talia Diker-Cohen
    Affiliations
    Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel

    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Internal Medicine A, Beilinson Hospital, Petach Tikva, Israel
    Search for articles by this author
  • Tali Steinmetz
    Affiliations
    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Department of Nephrology and Hypertension, Beilinson Hospital, Petach Tikva, Israel
    Search for articles by this author
  • Oren Amitai
    Affiliations
    Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel

    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • Ilan Shimon
    Affiliations
    Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel

    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author

      Highlights

      • Abnormal admission sodium values are associated with longer hospitalization.
      • Short- and long-term mortality risk is higher with hypernatremia and hyponatremia.
      • Mortality risk is higher with hypernatremia compared to hyponatremia on admission.
      • Mortality risk increased with severity of hyponatremia and hypernatremia.

      Abstract

      Aims

      Abnormal sodium values are common among hospitalized patients. We aimed to investigate the association of admission sodium values and mortality.

      Methods

      Historical prospectively data of adult patients hospitalized to medical wards between January 2011 and December 2013. Admission sodium values were classified to five categories: severe hyponatremia (<125 mEq/L), mild hyponatremia (125–135 mEq/L), normal sodium values (135–145 mEq/L), mild hypernatremia (145–150 mEq/L) and severe hypernatremia (>150 mEq/L). Main outcomes were length of hospitalization, in-hospital mortality and mortality at the end-of-follow-up.

      Results

      The cohort included 27,889 patients (mean age 67 ± 18 years, 52% males). The total follow-up was 1065 days. Most patients had normal sodium values (76%), 22% had hyponatremia, 3% had hypernatremia. Mean age increased with increase in severity of hyponatremia or hypernatremia. Median length of hospitalization was longer with mild and severe hypernatremia (7 and 5 days, respectively) or with mild and severe hyponatremia (4 and 4 days, respectively), compared to normal sodium levels (3 days). Compared to in-hospital mortality with normal sodium levels (5%), mortality was higher with mild and severe hyponatremia (9% and 14%, respectively) and was highest with mild (28%), and severe hypernatremia (52%). Mortality rate at the end of follow-up was 28% with normal sodium levels, 44% and 48% with mild and severe hyponatremia, 66% and 90% with mild and severe hypernatremia, respectively.

      Conclusions

      Abnormal sodium values on admission were associated with longer hospitalization and increased short- and long-term mortality. Mortality risk was higher with hypernatremia, compared to hyponatremia.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Arampatzis S.
        • Frauchiger B.
        • Fiedler G.M.
        • Leichtle A.B.
        • Buhl D.
        • Schwarz C.
        • et al.
        Characteristics, symptoms, and outcome of severe dysnatremias present on hospital admission.
        Am J Med. 2012; 125: 1125.e1-1125.e7https://doi.org/10.1016/j.amjmed.2012.04.041
        • Funk G.-C.
        • Lindner G.
        • Druml W.
        • Metnitz B.
        • Schwarz C.
        • Bauer P.
        • et al.
        Incidence and prognosis of dysnatremias present on ICU admission.
        Intensive Care Med. 2010; 36: 304-311https://doi.org/10.1007/s00134-009-1692-0
        • Lindner G.
        • Funk G.-C.
        • Schwarz C.
        • Kneidinger N.
        • Kaider A.
        • Schneeweiss B.
        • et al.
        Hypernatremia in the critically ill is an independent risk factor for mortality.
        Am J Kidney Dis. 2007; 50: 952-957https://doi.org/10.1053/j.ajkd.2007.08.016
        • Asadollahi K.
        • Beeching N.
        • Gill G.
        Hyponatraemia as a risk factor for hospital mortality.
        QJM. 2006; 99: 877-880https://doi.org/10.1093/qjmed/hcl120
        • Chawla A.
        • Sterns R.H.
        • Nigwekar S.U.
        • Cappuccio J.D.
        Mortality and serum sodium: do patients die from or with hyponatremia?.
        Clin J Am Soc Nephrol. 2011; 6: 960-965https://doi.org/10.2215/CJN.10101110
        • Clayton J.A.
        • Le Jeune I.R.
        • Hall I.P.
        Severe hyponatraemia in medical in-patients: aetiology, assessment and outcome.
        QJM. 2006; 99: 505-511https://doi.org/10.1093/qjmed/hcl071
        • Upadhyay A.
        • Jaber B.L.
        • Madias N.E.
        Incidence and prevalence of hyponatremia.
        Am J Med. 2006; 119: S30-S35https://doi.org/10.1016/j.amjmed.2006.05.005
        • Zilberberg M.D.
        • Exuzides A.
        • Spalding J.
        • Foreman A.
        • Jones A.G.
        • Colby C.
        • et al.
        Epidemiology, clinical and economic outcomes of admission hyponatremia among hospitalized patients.
        Curr Med Res Opin. 2008; 24: 1601-1608https://doi.org/10.1185/03007990802081675
        • Waikar S.S.
        • Mount D.B.
        • Curhan G.C.
        Mortality after hospitalization with mild, moderate, and severe hyponatremia.
        Am J Med. 2009; 122: 857-865https://doi.org/10.1016/j.amjmed.2009.01.027
        • Alsirafy S.A.
        • Sroor M.Y.
        • Al-Shahri M.Z.
        Predictive impact of electrolyte abnormalities on the admission outcome and survival of palliative care cancer referrals.
        J Palliat Med. 2009; 12: 177-180https://doi.org/10.1089/jpm.2008.0200
        • Whelan B.
        • Bennett K.
        • O'riordan D.
        • Silke B.
        Serum sodium as a risk factor for in-hospital mortality in acute unselected general medical patients.
        QJM. 2008; 102: 175-182https://doi.org/10.1093/qjmed/hcn165
        • Gheorghiade M.
        • Abraham W.T.
        • Albert N.M.
        • Gattis Stough W.
        • Greenberg B.H.
        • O'Connor C.M.
        • et al.
        Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry.
        Eur Heart J. 2007; 28: 980-988https://doi.org/10.1093/eurheartj/ehl542
        • Burkhardt K.
        • Kirchberger I.
        • Heier M.
        • Zirngibl A.
        • Kling E.
        • Von Scheidt W.
        • et al.
        Hyponatraemia on admission to hospital is associated with increased long-term risk of mortality in survivors of myocardial infarction.
        Eur J Prev Cardiol. 2015; 22: 1419-1426https://doi.org/10.1177/2047487314557963
        • Lim W.S.
        • Lewis S.
        • Macfarlane J.T.
        Severity prediction rules in community acquired pneumonia: a validation study.
        Thorax. 2000; 55: 219-223
        • Zugck C.
        • Krüger C.
        • Kell R.
        • Körber S.
        • Schellberg D.
        • Kübler W.
        • et al.
        Risk stratification in middle-aged patients with congestive heart failure: prospective comparison of the heart failure survival score (HFSS) and a simplified two-variable model.
        Eur J Heart Fail. 2001; 3: 577-585
        • Lewis J.R.
        • Hassan S.K.Z.
        • Wenn R.T.
        • Moran C.G.
        Mortality and serum urea and electrolytes on admission for hip fracture patients.
        Injury. 2006; 37: 698-704https://doi.org/10.1016/j.injury.2006.04.121
        • Hagino T.
        • Ochiai S.
        • Watanabe Y.
        • Senga S.
        • Saito M.
        • Takayama Y.
        • et al.
        Hyponatremia at admission is associated with in-hospital death in patients with hip fracture.
        Arch Orthop Trauma Surg. 2013; 133: 507-511https://doi.org/10.1007/s00402-013-1693-x
        • Rodrigues B.
        • Staff I.
        • Fortunato G.
        • McCullough L.D.
        Hyponatremia in the prognosis of acute ischemic stroke.
        J Stroke Cerebrovasc Dis. 2014; 23: 850-854https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.07.011
        • Gill G.
        • Huda B.
        • Boyd A.
        • Skagen K.
        • Wile D.
        • Watson I.
        • et al.
        Characteristics and mortality of severe hyponatraemia — a hospital-based study.
        Clin Endocrinol (Oxf). 2006; 65: 246-249https://doi.org/10.1111/j.1365-2265.2006.02583.x
        • Mohan S.
        • Gu S.
        • Parikh A.
        • Radhakrishnan J.
        NIH public access.
        Am J Med. 2013; 126: 1127-1137https://doi.org/10.1038/jid.2014.371
        • Krummel T.
        • Prinz E.
        • Metten M.
        • Borni-duval C.
        • Bazin-kara D.
        • Charlin E.
        • et al.
        Prognosis of patients with severe hyponatraemia is related not only to hyponatraemia but also to comorbidities and to medical management: results of an observational retrospective study.
        BMC Nephrol. 2016; : 1-12https://doi.org/10.1186/s12882-016-0370-z
        • Soupart A.
        • Decaux G.
        Therapeutic recommendations for management of severe hyponatremia: current concepts on pathogenesis and prevention of neurologic complications.
        Clin Nephrol. 1996; 46: 149-169
        • Baran D.
        • Hutchinson T.A.
        The outcome of hyponatremia in a general hospital population.
        Clin Nephrol. 1984; 22: 72-76
        • Renneboog B.
        • Musch W.
        • Vandemergel X.
        • Manto M.U.
        • Decaux G.
        Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits.
        Am J Med. 2006; 119: 71.e1-8https://doi.org/10.1016/j.amjmed.2005.09.026
        • Adrogué H.J.
        • Madias N.E.
        Hypernatremia.
        N Engl J Med. 2000; 342: 1493-1499https://doi.org/10.1056/NEJM200005183422006
        • Lenz K.
        • Gössinger H.
        • Laggner A.
        • Druml W.
        • Grimm G.
        • Schneeweiss B.
        Influence of hypernatremic-hyperosmolar state on hemodynamics of patients with normal and depressed myocardial function.
        Crit Care Med. 1986; 14: 913-914
        • Bratusch-Marrain P.R.
        • DeFronzo R.A.
        Impairment of insulin-mediated glucose metabolism by hyperosmolality in man.
        Diabetes. 1983; 32: 1028-1034
        • Knochel J.P.
        Neuromuscular manifestations of electrolyte disorders.
        Am J Med. 1982; 72: 521-535
        • Adrogué H.J.
        • Madias N.E.
        Hypernatremia.
        N Engl J Med. 2000; 342: 1493-1499https://doi.org/10.1056/NEJM200005183422006