Association between hypernatraemia acquired in the ICU and mortality: a cohort study

Darmon, Michaël; Timsit, Jean‐François; Français, Adrien; Nguilé-Makao, Molière; Adrie, Christophe; Cohen, Yves; Garrouste-Orgeas, Maïté; Goldgran-Tolédano, Dany; Dumenil, Anne-Sylvie; Jamali, Samir; Cheval, Christine; Allaouchiche, Bernard; Souweine, Bertrand; Azoulay, Élie

doi:10.1093/ndt/gfq067

Cited by 165 publications

(158 citation statements)

References 29 publications

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“…We found that 9.9% of admissions were associated with hypernatremia, an incidence similar to prior estimates of 1.3–9% in other populations using a similar definition of hypernatremia [1,2,3,20,21,22,23]. The wide range in these estimates is a reflection of the different populations studied.…”

Section: Discussionsupporting

confidence: 83%

“…Other multivariate analyses demonstrating an association of hypernatremia with mortality have used different methods for correcting for renal function. One study examined the Simplified Acute Physiology Score II and the Logistic Organ Dysfunction score at admission [21]. While this study accounted for chronic kidney disease at admission, the only variable that included AKI during the hospital course was the need for RRT.…”

Section: Discussionmentioning

confidence: 99%

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Dysnatremias and Survival in Adult Burn Patients: A Retrospective Analysis

Stewart

Morrow²,

Tilley³

et al. 2013

Am J Nephrol

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Background/Aims: Dysnatremias have been evaluated in many populations and have been found to be significantly associated with mortality. However, this relationship has not been well described in the burn population. Methods: Admissions to the burn center at our institution from January 2003 to December 2008 were examined. Independent variables included gender, age, percentage total body surface area burned (%TBSA), percentage of third-degree burn, inhalation injury, injury severity score (ISS), Acute Kidney Injury Network (AKIN) stage, hypernatremia, and hyponatremia. They were examined via Cox proportional hazard regression models against death. Moderate to severe hypo- and hypernatremia were defined as serum sodium <130 and >150 mmol/l, respectively. Results: In 1,969 subjects with a mean age of 36.3 ± 16.4 years, a median %TBSA of 9 (interquartile range 4–20) and a median ISS of 5 (interquartile range 1–16) hypernatremia occurred in 9.9% (n = 194), while hyponatremia occurred in 6.8% (n = 134) with mortality rates of 33.5 and 13.8%, respectively. Patients without a dysnatremia had a mortality rate of 4.3%. On Cox proportional hazard regression age, %TBSA, ISS, and AKIN stage were found to be significant predictors of mortality. Hypernatremia (HR 2.00, 95% CI 1.212–3.31; p = 0.0066), but not hyponatremia (HR 1.72, 95% CI 0.89–3.34; p = 0.1068) was associated with mortality. Conclusions: In the burn population, hypernatremia, but not hyponatremia, is an independent predictor of mortality.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Dysnatremias and Survival in Adult Burn Patients: A Retrospective Analysis

Stewart

Morrow²,

Tilley³

et al. 2013

Am J Nephrol

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“…12 Another study reported increasing mortality risk ratios of 2.32 and 3.64 in patients with mild (>150, ≤155 mEq/L) and severe (>155 mEq/L) hypernatremia. 13 It is therefore essential to prevent the onset of hypernatremia in patients treated with tolvaptan, which may cause hypernatremia event because of its aquaretic effect.…”

Section: Discussionmentioning

confidence: 97%

Novel Risk Score Efficiently Prevents Tolvaptan-Induced Hypernatremic Events in Patients With Heart Failure

Kinugawa

Sato

Inomata

et al. 2018

Circ J

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tions were reported to occur following tolvaptan treatment in a dose-dependent manner, with rates of 6%, 11%, and 13% for 30, 45, and 60 mg tolvaptan, respectively. 7 Although the risk of hypernatremia was not clear in the pivotal Phase 3 QUEST study, 8 we reported 3 risk factors for hypernatremic events using the interim results of the Samsca Post-Marketing Surveillance In the Heart faiLurE (SMILE) study conducted in 2014. 9 These factors were higher baseline sodium concentration, lower baseline potassium concentration, and a 15-mg starting dose of tolvaptan. Moreover, based on subanalysis of the SMILE study in 2015, 10 we recommended a lower dose of tolvaptan for older patients (i.e., those >80 years of age) to prevent hypernatremic events. Herein, we report on the development of a risk score to predict the prevalence of hypernatremia using the final dataset of the SMILE study. MethodsThe present prospective multicenter observational study was conducted in compliance with Good Post-Marketing Study Practice, an ordinance issued by the Ministry of Health, Labor and Welfare for the implementation of post-marketing surveillance of new drugs approved in Japan. The study period was from 2011 to 2016, and the D iuretic resistance was common in the Acute Decompensated Heart Failure Registry (ADHERE), 1 being observed in 30% of patients with heart failure. Until the approval of tolvaptan, a vasopressin V2 receptor antagonist, there were limited therapeutic options for patients with heart failure and fluid retention who did not respond sufficiently to conventional diuretics.Tolvaptan has been approved in the US since 2009, with current indications for tolvaptan being the treatment of clinically significant hypervolemic and euvolemic hyponatremia, as well as Syndrome of Inappropriate Antidiuretic Hormone (SIADH). 2 However, in Japan, tolvaptan was approved in 2010 for the following expanded indication, which is quite different from indications in the US: "volume overload in heart failure patients when adequate response was not obtained with other diuretics (e.g., loop diuretics)". 3,4 Tolvaptan significantly increases urine volume with water excretion into the urine 5 and sometimes results in marked increases in serum sodium concentrations. Therefore, tolvaptan treatment must be started in an inpatient setting to avoid the adverse event of hypernatremia caused by its pharmacological action of aquaresis. In the EVEREST study, in which patients were treated with 30 mg tolvaptan, the incidence of hypernatremia was 1.7%. 6 In another study, abnormally high serum sodium concentra- Sugitani, Toyama 930-0914, Japan. E-mail: kinugawa0422@gmail.com ISSN-1346-9843 All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: cj@j-circ.or.jp Novel Risk Score Efficiently Prevents Tolvaptan-Induced Hypernatremic Events in Patients With Heart FailureKoichiro Kinugawa, MD, PhD; Naoki Sato, MD, PhD; Takayuki Inomata, MD, PhD; Moriyoshi Yasuda, PhD; Yoshiyuki Shibasaki, BSc; Toshiyuki Shimakawa, BScBackgrou...

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“…Whereas some authors have defined hypernatremia as serum sodium ≥ 146 mEq/L, 5,18 or ≥ 150 mEq/L, 2,14,17 we chose to classify hypernatremia into mild, moderate, and severe, as described previously. 2,11 This categorization is especially important for patients with TBI, …”

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality associated with hypernatremia in patients with severe traumatic brain injury

Vedantam

Robertson

Gopinath

2017

Neurosurgical Focus

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OBJECTIVEHypernatremia is independently associated with increased mortality in critically ill patients. Few studies have evaluated the impact of hypernatremia on early mortality in patients with severe traumatic brain injury (TBI) treated in a neurocritical care unit.METHODSA retrospective review of patients with severe TBI (admission Glasgow Coma Scale score ≤ 8) treated in a single neurocritical care unit between 1986 and 2012 was performed. Patients with at least 3 serum sodium values were selected for the study. Patients with diabetes insipidus and those with hypernatremia on admission were excluded. The highest serum sodium level during the hospital stay was recorded, and hypernatremia was classified as none (≤ 150 mEq/L), mild (151–155 mEq/L), moderate (156–160 mEq/L), and severe (> 160 mEq/L). Multivariate Cox regression analysis was performed to determine independent predictors of early mortality.RESULTSA total of 588 patients with severe TBI were studied. The median number of serum sodium measurements for patients in this study was 17 (range 3–190). No hypernatremia was seen in 371 patients (63.1%), mild hypernatremia in 77 patients (13.1%), moderate hypernatremia in 50 patients (8.5%), and severe hypernatremia in 90 patients (15.3%). Hypernatremia was detected within the 1st week of admission in 79.3% of patients (n = 172), with the majority of patients (46%) being diagnosed within 72 hours after admission. Acute kidney injury, defined as a rise in creatinine of ≥ 0.3 mg/dl, was observed in 162 patients (27.6%) and was significantly associated with the degree of hypernatremia (p < 0.001). At discharge, 148 patients (25.2%) had died. Hypernatremia was a significant independent predictor of mortality (hazard ratios for mild: 3.4, moderate: 4.4, and severe: 8.4; p < 0.001). Survival analysis showed significantly lower survival rates for patients with greater degrees of hypernatremia (log-rank test, p < 0.001).CONCLUSIONSHypernatremia after admission in patients with severe TBI was independently associated with greater risk of early mortality. In addition to severe hypernatremia, mild and moderate hypernatremia were significantly associated with increased early mortality in patients with severe TBI.

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Association between hypernatraemia acquired in the ICU and mortality: a cohort study

Abstract: IAH is frequent and associated with mortality after adjustment on severity at ICU admission.

Cited by 165 publications

References 29 publications

Dysnatremias and Survival in Adult Burn Patients: A Retrospective Analysis

Dysnatremias and Survival in Adult Burn Patients: A Retrospective Analysis

Novel Risk Score Efficiently Prevents Tolvaptan-Induced Hypernatremic Events in Patients With Heart Failure

Morbidity and mortality associated with hypernatremia in patients with severe traumatic brain injury

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