Hyperosmolar dehydration: A predictor of kidney injury and outcome in hospitalised older adults

El‐Sharkawy, Ahmed M.; Devonald, Mark A.J.; Humes, David J.; Sahota, Opinder; Lobo, Dileep N.

doi:10.1016/j.clnu.2019.11.030

Cited by 24 publications

(18 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Impaired hydration is easily diagnosed by serum osmolality or alternatively by calculated serum osmolarity by validated formulas [24,25]. Dehydration may develop quickly in those at increased risk with life-threatening consequences both in hospital after discharge [22,[26][27][28]. Rapid identification of this condition allows to establish a prompt treatment, which results in complete reversibility in mild and impending forms.…”

Section: Introductionmentioning

confidence: 99%

Predictors of short- and long-term mortality among acutely admitted older patients: role of inflammation and frailty

et al. 2021

View full text Add to dashboard Cite

Background Frailty, demographic and clinical variables linked to incident diseases (e.g., dehydration, inflammation) contribute to poor outcomes in older patients acutely hospitalized. Their predictivity on short-, intermediate- and long-term mortality in a comprehensive model has been scarcely investigated. Aims To test the performance of a predictive tool considering frailty and inflammation as well as age, sex and impaired hydration status on 1-year mortality in acutely admitted older patients. Methods Retrospective observational study including 529 medical patients (age 84.6 ± 7.3 years). At hospital admission, frailty was assessed by the Multidimensional Prognostic Index (MPI). The Glasgow Prognostic Score (GPS) was used to grade systemic inflammation. Serum osmolarity was calculated to assess hydration. Results After adjusting for age, sex, GPS and osmolarity, the severe-risk MPI was a strong predictor for 1-year mortality (OR 4.133; 95% CI 2.273–7.516; p < 0.001). Age > 85 years, male sex, GPS-2 and serum osmolarity > 300 mOsm/L were independent predictors of mortality in the same multivariable model. The MPI alone showed a moderate discrimination power (AUC 0.678; 95% CI 0.628–0.729; p < 0.001) on 1-year mortality, which increased by 12.5% after the addition of the above predictors in the fully adjusted regression model (AUC 0.763; 95% CI 0.719–0.807; p < 0.001). The severe-risk MPI adjusted for the same factors was also an independent predictor of mortality after 60 and 180 days since hospital admission. Discussion Inflammation and impaired hydration are potentially modifiable risk factors for severe outcomes in older acutely hospitalized patients. A model combining GPS, age, gender, and plasma osmolarity improved the accuracy of MPI at admission in predicting long-term mortality.

show abstract

Section: Introductionmentioning

confidence: 99%

Predictors of short- and long-term mortality among acutely admitted older patients: role of inflammation and frailty

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Measures of plasma osmolality, including crystal osmolality and colloid osmolality, which play important roles in regulating the distribution of water in blood vessels and inside and outside cells, are included in routine biochemical tests ( 2 ). Previous studies have shown that plasma osmolality is associated with the prognosis of patients with heart failure ( 3 , 4 ), myocardial infarction ( 5 , 6 ), and diabetic ketoacidosis ( 7 ), patients undergoing hemodialysis ( 8 ), elderly patients ( 9 ), and patients in the emergency room ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Early Plasma Osmolality Levels and Clinical Outcomes in Children Admitted to the Pediatric Intensive Care Unit: A Single-Center Cohort Study

Wang

et al. 2021

Front. Pediatr.

View full text Add to dashboard Cite

Objective: Identifying high-risk children with a poor prognosis in pediatric intensive care units (PICUs) is critical. The aim of this study was to assess the predictive value of early plasma osmolality levels in determining the clinical outcomes of children in PICUs.Methods: We retrospectively assessed critically ill children in a pediatric intensive care database. The locally weighted-regression scatter-plot smoothing (LOWESS) method was used to explore the approximate relationship between plasma osmolality and in-hospital mortality. Linear spline functions and stepwise expansion models were applied in conjunction with a multivariate logistic regression to further analyze this relationship. A subgroup analysis by age and complications was performed.Results: In total, 5,620 pediatric patients were included in this study. An approximately “U”-shaped relationship between plasma osmolality and mortality was detected using LOWESS. In the logistic regression model using a linear spline function, plasma osmolality ≥ 290 mmol/L was significantly associated with in-hospital mortality [odds ratio (OR) 1.020, 95% confidence interval (CI) 1.010–1.031], while plasma osmolality <290 mmol/L was not significantly associated with in-hospital mortality (OR 0.990, 95% CI 0.966–1.014). In the logistic regression model with plasma osmolality as a tri-categorical variable, only high osmolality was significantly associated with in-hospital mortality (OR 1.90, 95% CI 1.38–2.64), whereas low osmolality was not associated with in-hospital mortality (OR 1.28, 95% CI 0.84–1.94). The interactions between plasma osmolality and age or complications were not significant.Conclusion: High osmolality, rather than low osmolality, can predict a poor prognosis in children in PICUs.

show abstract

“…have shown that the prevalence rate of HD among hospitalized patients was 27%. 9 Based on a recent cohort study conducted in 2015, the prevalence rate of HD was 37% among hospitalized older patients with acute illness. 11 Our study included patients admitted to the ED who were either discharged to home or admitted to the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Results showed that a high proportion of dehydrated patients presented with acute renal failure after admission, and these patients had a 1.6 times higher 30-day mortality rate than those without dehydration. 9 The prevalence of hypertonic dehydration (HD) among community-dwelling older populations has been evaluated globally. In the UK DRIE study, the prevalence rate of HD was 20% among community-dwelling older adults.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors of hypertonic dehydration among older patients admitted to the emergency department: A prospective cross‐sectional study

Buaprasert

Piyapaisarn

Vanichkulbodee

et al. 2021

Geriatrics Gerontology Int

View full text Add to dashboard Cite

The prevalence of hypertonic dehydration (HD) among community-dwelling and hospitalized populations has been evaluated. However, to our knowledge, no study had previously focused on older patients admitted to the emergency department (ED). The present study aimed to evaluate the prevalence, risk factors and short-term outcomes of HD among Thai older patients admitted to the ED.Methods: This was a prospective cross-sectional study at one urban ED in Thailand. Patients aged ≥65 years who were admitted to the ED were enrolled into the study. Data including clinical hydration status, Charlson Comorbidity Index (CCI) score, activities of daily living score, current use of medications, laboratory examination results and serum osmolarity level were collected. HD was defined as a serum osmolarity level of >300 mOsm/kg. The short-term outcomes were a 30-day ED revisit, hospital readmission and mortality rates.Results: In total, 80 (21.6%) of 370 patients presented with HD. A CCI score of ≥5 was found associated with HD among older patients (adjusted odds ratio: 1.82; 95% confidence interval: 1.03-3.21). The ED revisit rates were 18.1% in the dehydrated group and 10.9% in the non-dehydrated group. The hospital readmission rates were 8.3% in the dehydrated group and 10.6% in the non-dehydrated group. Furthermore, the 30-day mortality rates were 6.9% and 5.3% in the dehydrated and non-dehydrated groups, respectively.Conclusions: One-fifth of older patients admitted to the ED presented with HD. A CCI score of ≥5 was considered a risk factor of HD. Moreover, further studies should focus on the long-term outcomes of HD and risk reduction.

show abstract

Hyperosmolar dehydration: A predictor of kidney injury and outcome in hospitalised older adults

Cited by 24 publications

References 35 publications

Predictors of short- and long-term mortality among acutely admitted older patients: role of inflammation and frailty

Predictors of short- and long-term mortality among acutely admitted older patients: role of inflammation and frailty

Early Plasma Osmolality Levels and Clinical Outcomes in Children Admitted to the Pediatric Intensive Care Unit: A Single-Center Cohort Study

Prevalence and risk factors of hypertonic dehydration among older patients admitted to the emergency department: A prospective cross‐sectional study

Contact Info

Product

Resources

About