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Mild to moderate hyponatremia at discharge is associated with increased risk of recurrence in patients with community-acquired pneumonia

  • Author Footnotes
    + equally contributing first authors
    Laura Potasso
    Correspondence
    Corresponding author at: University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland.
    Footnotes
    + equally contributing first authors
    Affiliations
    Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland

    Department of Clinical Research, University of Basel, Basel, Switzerland
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  • Author Footnotes
    + equally contributing first authors
    Clara Odilia Sailer
    Footnotes
    + equally contributing first authors
    Affiliations
    Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland

    Department of Clinical Research, University of Basel, Basel, Switzerland
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  • Author Footnotes
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    Claudine Angela Blum
    Footnotes
    + equally contributing first authors
    Affiliations
    Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland

    Division of General Internal and Emergency Medicine, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland

    Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
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  • Nicole Cesana-Nigro
    Affiliations
    Department of Endocrinology and Diabetology, Bürgerspital Solothurn, Solothurn, Switzerland
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  • Philipp Schuetz
    Affiliations
    Division of General Internal and Emergency Medicine, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland

    Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
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  • Beat Mueller
    Affiliations
    Division of General Internal and Emergency Medicine, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland

    Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
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  • Mirjam Christ-Crain
    Affiliations
    Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland

    Department of Clinical Research, University of Basel, Basel, Switzerland
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Published:January 14, 2020DOI:https://doi.org/10.1016/j.ejim.2019.12.009

      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

      Keywords

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