Highlights
- •Hyponatraemia at admission predicts in-hospital mortality.
- •This effect is largely modulated through illness severity and case complexity.
- •The frequency of abnormal admission sodium has decreased over time.
- •In-hospital mortality has also decreased over time.
Abstract
Background
Altered sodium balance at time of an emergency medical admission adversely impacts
on outcome; whether hyponatraemia is independently associated with outcomes or a surrogate
of acute illness severity has been debated.
Methods
All emergency medical admissions between 2002 and 2017 were studied and a risk score
calculated. We compared univarate deciles of admission sodium using a multivariable
model, adjusting for risk score.
Results
There were 106,586 admissions in 54,928 patients. Patients with lower sodium at admission
were older at 66.7 years (IQR 46.7–79.5) compared with 63.3 years (IQR 42.9–78.2)
with a longer length of stay (LOS) of 6.8 days (IQR 3.0–14.7) versus 4.9 days (IQR
1.8–10.9). They had a higher 30-day in-hospital mortality at 6.4% vs 4.4% (p < 0.001).
Admission sodium predicted survival – OR 0.89 (95%CI 0.88–0.90). We adjusted the model
with a Risk Score that is predictive and exponentially related to 30-day in-hospital
mortality. When adjusted for Risk Score, the admission sodium value was less predictive
– OR 0.95 (95%CI 0.92–0.97). The cumulative percentages within the lowest five deciles
fell from 63.3% between 2002 and 2009 to 48.1% from 2010 to 2017. The slope of the
prediction line relating admission sodium to mortality did not change over time but
a lower mortality rate was predicted at any given sodium level.
Conclusion
Hyponatraemia at the time of an emergency medical admission is predictive and probably
a marker of Acuity Illness Severity and Case Complexity. Both the frequency of abnormality
in admission sodium and mortality have fallen over time.
Keywords
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Article info
Publication history
Published online: August 07, 2018
Accepted:
August 1,
2018
Received in revised form:
July 23,
2018
Received:
June 25,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
