Highlights
- •Hyponatremia is a common electrolyte disorder in hospitalized patients with CAP.
- •Discharge hyponatremia is associated with increased pneumonia recurrence rate.
- •Admission hyponatremia is associated with increased pneumonia recurrence rate.
- •Recurrence rate is lower in patients with resolution of admission hyponatremia.
Abstract
Background
Hyponatremia is the most common electrolyte disorder in hospitalized patients with
pneumonia. Different studies have shown an association of hyponatremia on admission
and worse patient's outcome. Yet, the impact of hyponatremia at discharge or of hyponatremia
correction on patient's prognosis is unknown.
Methods
This is a preplanned secondary data analysis from a double-blind, randomized, placebo-controlled
trial of hospitalized patients with community-acquired pneumonia and prednisone treatment.
The primary outcome was the impact of hyponatremia on admission and at discharge on
patient relevant outcomes (i.e. mortality, rehospitalization and recurrence rate)
within 180 days.
Results
Of the 708 included patients, 185 (26.1%) were hyponatremic on admission. Of these,
28 (15.1%) were still hyponatremic at discharge. 34 (4.8%) patients developed hyponatremia
during hospitalization despite being normonatremic on admission. Patients with hyponatremia
at discharge had a higher rate of pneumonia recurrence as compared to normonatremic
patients (OR 2.68; 95%-CI 1.09–6.95; p = 0.037). Among patients with hyponatremia at discharge, patients who were already
hyponatremic on admission showed the strongest association with increased recurrence
rate (OR 4.01; 95%-CI 1.08–12.64; p = 0.022). In contrast, recurrence rate was not affected in patients who were hyponatremic
on admission but had normalized serum sodium levels at discharge (p = 0.73).
Conclusion
Mild to moderate hyponatremia at discharge is associated with an increased risk of
recurrence in hospitalized patients with pneumonia. This association is particularly
strong for patients who are hyponatremic both on admission and at discharge, emphasizing
the importance of hyponatremia correction during hospitalization.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: January 14, 2020
Accepted:
December 17,
2019
Received in revised form:
December 5,
2019
Received:
September 17,
2019
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
