Highlights
- •Hyponatraemia (<130 mmol/L) predicts poor outcome in patients admitted with pneumonia.
- •Hyponatraemia is an independent risk factor for hospital mortality and ICU admission.
- •Hyponatraemia on admission is not associated with length of hospitalisation.
Abstract
Background
Hyponatraemia on hospital admission has been shown to be a risk factor for illness
severity in critically ill patients. The aim of the present study was to investigate
whether hyponatraemia on emergency department (ED) admission independently influences
in-hospital mortality, ICU admission, and/or length of hospitalisation in patients
with pneumonia.
Methods
610 patients (64.4% male, median 66 years) diagnosed with pneumonia were identified
by retrospective screening of electronic admission data (06/2011–06/2013). Patients
were admitted to the ED of Bern University Hospital, Switzerland. Patient characteristics,
potential confounders, and patient-centred clinical outcomes, including mortality,
ICU admission, and length of hospitalisation, were analysed. Multivariate logistic
analysis adjusted for typical confounders was performed to analyse the association
of hyponatraemia with clinical outcomes.
Results
In a large cohort of consecutive acutely admitted patients with pneumonia, the overall
in-hospital mortality rate was 12.5%; 21.2% of patients required primary or secondary
ICU admission, and the median length of hospital stay was 8 (IQR 5–13) days. At baseline,
47 patients (7.7%) were found to have concomitant hyponatraemia. Multivariate regression
revealed a significant association between hyponatraemia and in-hospital mortality
(adjusted OR: 2.7, 95% CI: 1.3–5.9, p = 0.010), but not with ICU admission (adjusted OR: 1.8, 95% CI: 0.9–3.6, p = 0.103) or length of hospitalisation (p = 0.493) after adjustment for age, neoplasia, COPD, suspected sepsis, and cardiac
disease. The association was robust if controlled for other covariates, e.g. CRB-65
score.
Conclusions
Hyponatraemia on admission predicts poor outcome and is an independent risk factor
for in-hospital mortality in admitted patients diagnosed with pneumonia.
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 accessOne-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 MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Burden of adult community-acquired, healthcare-associated, hospital-acquired, and ventilator-associated pneumonia: New York City, 2010–2014.Chest. 2017; 152: 930-942
- The burden of illness in patients with hyponatraemia in Sweden: a population-based registry study.Int J Clin Pract. 2016; 70: 319-329
- Age and gender as risk factors for hyponatremia and hypernatremia.Clin Chim Acta. 2003; 337: 169-172
- Hyponatremia in critically ill patients.Indian J Crit Care Med. 2014; 18: 83-87
- Hyponatremia in community-acquired pneumonia.Am J Nephrol. 2007; 27: 184-190
- Hyponatremia and hospital outcomes among patients with pneumonia: a retrospective cohort study.BMC Pulm Med. 2008; 8: 16
- Epidemiology, clinical and economic outcomes of admission hyponatremia among hospitalized patients.Curr Med Res Opin. 2008; 24: 1601-1608
- Cost of illness of hyponatremia in the United States.Cost Eff Resour Alloc. 2006; 4: 10
- Economic impact of hyponatremia in hospitalized patients: a retrospective cohort study.Postgrad Med. 2009; 121: 186-191
- Cost and resource allocation issues in managing hyponatremia: the pharmacist's role.Pharmacotherapy. 2011; 31: 25S-30S
- APACHE II: a severity of disease classification system.Crit Care Med. 1985; 13: 818-829
- Hyponatremia in pneumonia.J Hosp Med. 2012; 7: S11-3
- Hyponatremia in patients with community acquired pneumonia.JNMA J Nepal Med Assoc. 2016; 54: 67-71
- Emergency medicine in Switzerland.ICU Manage Pract. 2015; 15
- Utility of quick sepsis-related organ failure assessment (qSOFA) to predict outcome in patients with pneumonia.PLoS One. 2017; 12: e0188913
- Hypernatremia in the critically ill is an independent risk factor for mortality.Am J Kidney Dis. 2007; 50: 952-957
- Acquired hypernatraemia is an independent predictor of mortality in critically ill patients.Anaesthesia. 2009; 64: 514-520
- Risk factors for community-acquired pneumonia in adults: a population-based case-control study.Eur Respir J. 1999; 13: 349-355
- Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements.BMC Med. 2014; 12
- Nosocomial pneumonia: lessons learned.Crit Care Clin. 2013; 29: 521-546
- CRB-65 predicts death from community-acquired pneumonia.J Intern Med. 2006; 260: 93-101
- Hyponatremia and predictive rules for prognosis in adult patients with community-acquired pneumonia.J Infect. 2010; 60: 503-505
- Simulation study of confounder-selection strategies.Am J Epidemiol. 1993; 138: 923-936
- The impact of confounder selection criteria on effect estimation.Am J Epidemiol. 1989; 129: 125-137
- Selection of confounding variables should not be based on observed associations with exposure.Eur J Epidemiol. 2011; 26: 589-593
- Practical multivariate analysis.CRC Press, 2011
- Variable selection with stepwise and best subset approaches.Ann Transl Med. 2016; 4: 136
- A prediction rule to identify low-risk patients with community-acquired pneumonia.N Engl J Med. 1997; 336: 243-250
- Quality of reporting of multivariable logistic regression models in Chinese clinical medical journals.Medicine. 2017; 96: e6972
- ICU admission and severity assessment in community-acquired pneumonia.Crit Care. 2009; 13: 156
Article info
Publication history
Published online: April 13, 2018
Accepted:
April 8,
2018
Received in revised form:
March 13,
2018
Received:
September 7,
2017
Identification
Copyright
© 2018 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
