Association Between an Increase in Serum Sodium and In-Hospital Mortality in Critically Ill Patients*

Abstract

OBJECTIVES: In critically ill patients, dysnatremia is common, and in these patients, in-hospital mortality is higher. It remains unknown whether changes of serum sodium after ICU admission affect mortality, especially whether normalization of mild hyponatremia improves survival. DESIGN: Retrospective cohort study. SETTING: Ten Dutch ICUs between January 2011 and April 2017. Patients: Adult patients were included if at least one serum sodium measurement within 24 hours of ICU admission and at least one serum sodium measurement 24–48 hours after ICU admission were available. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A logistic regression model adjusted for age, sex, and Acute Physiology and Chronic Health Evaluation-IV–predicted mortality was used to assess the difference between mean of sodium measurements 24–48 hours after ICU admission and first serum sodium measurement at ICU admission (Δ48 hr-[Na]) and in-hospital mortality. In total, 36,660 patients were included for analysis. An increase in serum sodium was independently associated with a higher risk of in-hospital mortality in patients admitted with normonatremia (Δ48 hr-[Na] 5–10 mmol/L odds ratio: 1.61 [1.44–1.79], Δ48 hr-[Na] > 10 mmol/L odds ratio: 4.10 [3.20–5.24]) and hypernatremia (Δ48 hr-[Na] 5–10 mmol/L odds ratio: 1.47 [1.02–2.14], Δ48 hr-[Na] > 10 mmol/L odds ratio: 8.46 [3.31–21.64]). In patients admitted with mild hyponatremia and Δ48 hr-[Na] greater than 5 mmol/L, no significant difference in hospital mortality was found (odds ratio, 1.11 [0.99–1.25]). CONCLUSIONS: An increase in serum sodium in the first 48 hours of ICU admission was associated with higher in-hospital mortality in patients admitted with normonatremia and in patients admitted with hypernatremia.

The authors reply

“…They raised some important points regarding the challenges of observational studies using existing datasets. We agree that our study on the association between an increase of serum sodium during the first 2 days after ICU admission and mortality raises additional questions, for example, on the influence of fluid balance and of administered fluids and medications (2). We have addressed this in the discussion section of our article.…”

Association between serum sodium and in-hospital mortality among critically ill patients with spontaneous subarachnoid hemorrhage

“…Disorders of sodium commonly are encountered in critically ill patients during ICU admission ( 17 ). It is well suggested that sodium metabolism is strictly regulated by the kidney through the interaction of many neurohormonal mechanisms, including the renin-angiotoxin-aldosterone system ( 18 ).…”

Dysnatremia is associated with increased risk of all-cause mortality within 365 days post-discharge in patients with atrial fibrillation without heart failure: A prospective cohort study

“…Our study suggests that hypernatremia at the time of hospital admission is highly related to risk of adjusted all-cause mortality within 365 days after discharge for AF patients without HF. Studies have reported that hypernatremia indicates adverse prognosis for the medical patients ( 14 , 33 – 35 ). Breen et al showed the same result in a cardiac intensive care unit in a retrospective study ( 14 ).…”