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Corrigendum to: Antipsychotics and severe hyponatremia: A Swedish population-based case-control study. Eur J Intern Med. 2019 Feb;60:71-77.

  • Henrik Falhammar
    Correspondence
    Corresponding author: Henrik Falhammar, Department of Molecular Medicine and Surgery, Karolinska Institutet, D02:04, SE-171 76 Stockholm, Sweden.
    Affiliations
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
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  • Jonatan D. Lindh
    Affiliations
    Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
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  • Jan Calissendorff
    Affiliations
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
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  • Jakob Skov
    Affiliations
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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  • David Nathanson
    Affiliations
    Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden

    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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  • Buster Mannheimer
    Affiliations
    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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      The authors regret that in preparation of a new article based on the same data as in the previous published article [
      • Falhammar H
      • Lindh JD
      • Calissendorff J
      • Skov J
      • Nathanson D
      • Mannheimer B.
      Antipsychotics and severe hyponatremia: A Swedish population-based case-control study.
      ], we unfortunately discovered two errors in the dataset. Some cases of hyponatremia as a secondary diagnosis had erroneously been included as primary diagnosis of hyponatremia. The corrected number of cases admitted with a primary diagnosis of hyponatremia decreased to 11,213 instead of 14,359 as reported in the article, and as a consequence the number of matched controls decreased to 44,801 instead of 57,382. The second error in the dataset was that the index date, initially labelled as the date of admission by the National Board of Health and Welfare was in fact the discharge date. After correcting for these two errors, results were overall similar, with slight differences as specified below.
      Antipsychotics and hospitalization due to hyponatremia
      Tabled 1
      Antipsychotic CORRECTED Crude OR (95% CI)Antipsychotic INCORRECT Crude OR (95% CI)Antipsychotic CORRECTED Adj. OR (95% CI)Antipsychotic INCORRECT Adj. OR (95% CI)
      FGA
      Chlorpromazine57022 (0; NA)11.99 (1.54; 242)8569 (0; NA)1.63 (0.19; 34.92)
      Chlorprotixene22.00 (5.91; 142)15.00 (5.44; 52.63)4.35 (0.78; 12.09)4.10 (1.01; 18.98)
      Dixyrazine3.20 (0.79; 12.09)7.67 (3.89; 15.94)1.11 (0.24; 4.81)3.09 (1.36; 7.19)
      Flupentixol2.81 (1.86; 4.20)2.89 (1.98; 4.10)1.61 (0.98; 2.62)1.48 (0.95; 2.28)
      Fluphenazine5.99 (0.99; 45.52)5.33 (1.17; 27.06)5.00 (0.48; 51.10)3.81 (0.56; 25.23)
      Haloperidol2.59 (2.03; 3.28)2.80 (2.27; 3.43)1.22 (0.91; 1.65)1.26 (0.98; 1.62)
      Levomepromazine5.35 (4.14; 6.95)5.49 (4.36; 6.93)1.74 (1.24-2.43)1.65 (1.21; 2.23)
      Melperone3.23 (1.80; 5.73)3.36 (1.98; 5.65)1.80 (0.90; 3.54)1.89 (0.99; 3.44)
      Perphenazine5.96 (3.90; 9.22)5.78 (3.93; 8.59)4.23 (2.47; 7.30)3.84 (2.37; 6.24)
      Prochlorperazine8.00 (2.84; 25.68)9.50 (4.31; 23.04)5.93 (1.82; 21.65)5.96 (2.41; 16.01)
      Thioridazine23.00 (4.19; 453)11.99 (2.76; 81.86)11.01 (1.29; 231)5.64 (0.88; 44.52)
      Zuclopenthixole7.73 (5.28; 11.49)6.92 (4.97; 9.74)4.14 (2.57; 6.69)4.36 (2.87; 6.63)
      SGA
      Aripiprazole3.54 (2.01; 6.21)3.49 (2.07; 5.84)0.95 (0.45; 1.95)0.72 (0.36; 1.41)
      Clozapine6.68 (3.92; 11.65)7.05 (4.35; 11.68)5.36 (2.75; 10.54)5.42 (2.97; 9.99)
      Olanzapine4.69 (3.75; 5.87)4.80 (3.93; 5.87)2.25 (1.69; 2.99)2.23 (1.72; 2.88)
      Paliperidone4.00 (0.94; 16.90)4.00 (0.94; 16.91)3.41 (0.68; 16.52)3.86 (0.76; 18.79)
      Quetiapine3.88 (2.86; 5.25)4.27 (3.22; 5.67)1.69 (1.15; 2.47)1.72 (1.21; 2.45)
      Risperidone1.54 (1.29; 1.83)1.60 (1.37; 1.86)0.89 (0.72; 1.10)0.85 (0.70; 1.02)
      Ziprasidone4.66 (1.55; 14.49)6.28 (2.47; 17.08)2.95 (0.78; 10.76)2.45 (0.74; 8.18)
      Any FGA4.03 (3.51; 4.62)4.21 (3.73; 4.74)2.15 (1.81; 2.54)2.12 (1.83; 2.46)
      Any SGA2.57 (2.28; 2.89)2.64 (2.37; 2.93)1.37 (1.18; 1.59)1.32 (1.15; 1.51)
      Any antipsychotic2.95 (2.68; 3.24)3.08 (2.83; 3.35)1.72 (1.53; 1.94)1.67 (1.50; 1.86)
      FGA, first-generation antipsychotics. SGA, second-generation antipsychotics.
      When re-analyzing newly initiated antipsychotic therapy separated from ongoing treatment, the associations between newly initiated treatment and hyponatremia changed only slightly, while the association for ongoing treatment were somewhat more pronounced. However, the data on newly initiated treatment with antipsychotics was only considered a minor finding in the published article.
      Tabled 1
      Newly initiated antipsychoticCORRECTEDAdj. OR (95% CI)Newly initiated antipsychoticINCORRECTAdj. OR (95% CI)Ongoingantipsychotic CORRECTEDAdj. OR (95% CI)Ongoingantipsychotic INCORRECTAdj. OR (95% CI)
      FGA
      Dixyrazine0.89 (0.03; 13.92)33.81 (5.72; 648)1.50 (0.26; 8.60)1.11 (0.38; 3.12)
      Haloperidol1.55 (0.80; 2.93)2.20 (1.34; 3.60)1.16 (0.83; 1.62)1.05 (0.78; 1.40)
      Levomepromazine1.03 (0.32; 3.31)1.25 (0.49; 3.23)1.84 (1.30; 2.62)1.75 (1.27; 2.42)
      Melperone3.11 (0.60; 12.92)3.24 (0.89; 11.06)1.59 (0.72; 3.38)1.60 (0.78; 3.23)
      Perphenazine12.15 (1.21; 263)10.04 (1.81; 82.31)4.11 (2.35; 7.20)3.58 (2.16; 5.95)
      Prochlorperazine27.59 (3.70; 574)23.48 (5.53; 164)2.14 (0.43; 10.78)1.64 (0.44; 6.21)
      Zuclopenthixole2.00 (0.31; 11.11)4.08 (1.10; 15.02)4.39 (2.67; 7.27)4.43 (2.85; 6.92)
      SGA
      Aripiprazole1.62 (0.37; 6.82)1.16 (0.30; 4.46)0.77 (0.32; 1.76)0.62 (0.27; 1.34)
      Clozapine0.32 (0.02; 7.74)2.24 (0.14; 80.11)6.11 (3.11; 12.13)5.97 (3.21; 11.23)
      Olanzapine0.89 (0.36; 2.18)1.19 (0.56; 2.49)2.48 (1.84; 3.34)2.42 (1.85; 3.18)
      Quetiapine1.31 (0.57; 2.95)1.49 (0.69; 3.19)1.88 (1.21; 2.88)1.80 (1.20; 2.67)
      Risperidone0.65 (0.36; 1.12)0.86 (0.56; 1.31)0.95 (0.75; 1.19)0.83 (0.67; 1.02)
      Any FGA1.74 (1.09; 2.75)2.94 (2.09; 4.13)2.24 (1.86; 2.69)1.98 (1.68; 2.33)
      Any SGA0.84 (0.55; 1.27)1.05 (0.75; 1.47)1.47 (1.25; 1.73)1.37 (1.18; 1.59)
      Any antipsychotic1.01 (0.70; 1.44)1.80 (1.38; 2.34)1.83 (1.62; 2.08)1.65 (1.47; 1.85)
      FGA, first-generation antipsychotics. SGA, second-generation antipsychotics.
      The conclusion in the published article was “There was an association between antipsychotic therapy and hospitalization due to hyponatremia. The association was stronger for FGAs than SGAs. Risperidone was not associated with an increased risk.”
      In the light of the revised analysis, the conclusion does not need to be changed at all.
      The authors would like to apologise for any inconvenience caused.

      Reference

        • Falhammar H
        • Lindh JD
        • Calissendorff J
        • Skov J
        • Nathanson D
        • Mannheimer B.
        Antipsychotics and severe hyponatremia: A Swedish population-based case-control study.
        Eur J Intern Med. 2019; 60: 71-77

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