Hyponatremia prolongs hospital stay and hypernatremia better predicts mortality than hyponatremia in hospitalized patients with community-acquired pneumonia

Akyıl, Fatma Tokgöz; Akyıl, Mustafa; Ağca, Meltem; Gungor, Aylin; Ozantürk, Erdal; Söğüt, Gökhan; Bekir, Sümeyye Alparslan; Topbaş, Ahmet; Türker, Hatice; Sevim, Tülin

doi:10.5578/tt.68779

Cited by 17 publications

(15 citation statements)

References 17 publications

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“…As in the case of hyponatremia, multivariable analysis revealed that hypernatremia was independently associated with mortality, with a HR of 1.75. Our findings confirm those of Akyil et al in a smaller retrospective study of 25 patients with CAP and baseline hypernatremia (6).…”

Section: Discussionsupporting

confidence: 92%

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Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis

et al. 2020

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Dysnatremia is associated with increased mortality in patients with community-acquired pneumonia. SARS-COV2 (Severe-acute-respiratory syndrome caused by Coronavirus-type 2) pneumonia can be fatal. The aim of this study was to ascertain whether admittance dysnatremia is associated with mortality, sepsis, or intensive therapy (IT) in patients hospitalized with SARS-COV2 pneumonia. This is a retrospective study of the HOPE-COVID-19 registry, with data collected from January 1th through April 31th, 2020. We selected all hospitalized adult patients with RT-PCR-confirmed SARS-COV2 pneumonia and a registered admission serum sodium level (SNa). Patients were classified as hyponatremic (SNa <135 mmol/L), eunatremic (SNa 135–145 mmol/L), or hypernatremic (SNa >145 mmol/L). Multivariable analyses were performed to elucidate independent relationships of admission hyponatremia and hypernatremia, with mortality, sepsis, or IT during hospitalization. Four thousand six hundred sixty-four patients were analyzed, median age 66 (52–77), 58% males. Death occurred in 988 (21.2%) patients, sepsis was diagnosed in 551 (12%) and IT in 838 (18.4%). Hyponatremia was present in 957/4,664 (20.5%) patients, and hypernatremia in 174/4,664 (3.7%). Both hyponatremia and hypernatremia were associated with mortality and sepsis. Only hyponatremia was associated with IT. In conclusion, hyponatremia and hypernatremia at admission are factors independently associated with mortality and sepsis in patients hospitalized with SARS-COV2 pneumonia.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT04334291, NCT04334291.

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Section: Discussionsupporting

confidence: 92%

“…Studies have reported a prevalence of hyponatremia at admission with CAP ranging from 8 to 28% (3,5), when hyponatremia is defined as a serum sodium level (SNa) <135 mmol/L. On the other hand, the prevalence of hypernatremia in these patients, as defined by a SNa >145 mmol/L, is much lower, with a prevalence of 5.3% (6).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis

et al. 2020

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“…We found an incidence of 1.6% among patients with COVID-19. This number is lower than the incidences reported in previous studies (2.9%–38%)16 39 and lower than the incidence of hypernatraemia (5.3%) reported in patients with a community acquired pneumonia 45. Patients with hypernatraemia were found to be older than patients with normonatremia or hyponatraemia.…”

Section: Discussioncontrasting

confidence: 63%

What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals

de Haan,

ten Wolde,

Beudel

et al. 2023

BMJ Open

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ObjectivesTo evaluate the relationship among dysnatraemia at hospital presentation and duration of admission, risk of intensive care unit (ICU) admission and all-cause mortality and to assess the underlying pathophysiological mechanism of hyponatraemia in patients with COVID-19. Our hypothesis is that both hyponatraemia and hypernatraemia at presentation are associated with adverse outcomes.DesignObservational study.SettingSecondary care; 11 Dutch hospitals (2 university and 9 general hospitals).ParticipantsAn analysis was performed within the retrospective multicentre cohort study COVIDPredict. 7811 patients were included (60% men, 40% women) between 24 February 2020 and 9 August 2022. Patients who were ≥18 years with PCR-confirmed COVID-19 or CT with COVID-19 reporting and data system score≥4 and alternative diagnosis were included. Patients were excluded when serum sodium levels at presentation were not registered in the database or when they had been transferred from another participating hospital.Outcome measuresWe studied demographics, medical history, symptoms and outcomes. Patients were stratified according to serum sodium concentration and urinary sodium excretion.ResultsHyponatraemia was present in 2677 (34.2%) patients and hypernatraemia in 126 (1.6%) patients. Patients with hyponatraemia presented more frequently with diarrhoea, lower blood pressure and tachycardia. Hyponatraemia was, despite a higher risk for ICU admission (OR 1.27 (1.11–1.46; p<0.001)), not associated with mortality or the risk for intubation. Patients with hypernatraemia had higher mortality rates (OR 2.25 (1.49–3.41; p<0.001)) and were at risk for ICU admission (OR 2.89 (1.83–4.58)) and intubation (OR 2.95 (1.83–4.74)).ConclusionsHypernatraemia at presentation was associated with adverse outcomes in patients with COVID-19. Hypovolaemic hyponatraemia was found to be the most common aetiology of hyponatraemia. Hyponatraemia of unknown aetiology was associated with a higher risk for ICU admission and intubation and longer duration of admission.

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“…However, some elements of disease severity are not intercepted by these scoring systems; among these, electrolyte disturbances, which may mark or contribute to serious complications are not fully included. Speci cally, sodium disorders which are common in both critically and non-critically ill patients [8] have been independently associated with poor outcomes and mortality in patients hospitalized for different diseases, such as chronic obstructive pulmonary disease (COPD) or pneumonia [9][10][11][12]. Nonetheless, sodium is not included in CURB-65, the most commonly used severity score, and the Pneumonia Severity Index (PSI) [10] includes only hyponatremia (with a value below 130 mEq/L), but not hypernatremia as item of the scoring system.…”

Section: Introductionmentioning

confidence: 99%

Hypernatremia and risk of death in patients hospitalized for community acquired pneumonia: findings from the FADOI-ICECAP study

Giarretta,

Pieralli,

Carleo

et al. 2024

Preprint

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Introduction: Community-acquired pneumonia (CAP) is a frequent cause of admission to internal medicine units (IMUs). CAP-mortality is still high and it is necessary to identify possible risk factors for unfavorable outcomes. In this study we evaluated the effect of hypernatremia on mortality and the need for intensive care admission in CAP-patients admitted to internal medicine units (IMUs). Methods: We included 1241 patients hospitalized for CAP in 26 Italian IMUs from October 2016 to February 2018. Univariate and multivariate analyses were performed to evaluate the association between patients’ clinical characteristic, disease severity and sodium disorders with need for ICU admission and 30-day mortality . Results: The prevalence of hypernatremia was 5.7% (95%, CI: 4.41-6.99) and was significantly associated with 30-day mortality (OR 3.88, 95% CI 2.18-6.90) while no association with need for ICU admission was found. Other variables associated with 30-day mortality were age >75 years (OR 3.11, 95 CI 1.81-5.35); multilobar infiltrates at chest imaging (1.54, 95% CI 1.03-2.32); cancer (OR 6.32, 95% CI 3.22-12.4); dementia (OR 2.78, 95% CI 1.80-4.31) and chronic kidney disease (OR 1.70, 95% CI 1.03-2.80). Mortality in patients with 0, 1, 2, 3, or ≥ 4 risk factors progressively increased. Based on the number of risk factors in each patient we defined three risk categories that defined the short-term prognosis of this cohort better than PSI and CURB-65 (AUC 0.71 vs 0.63 and 0.64 respectively). Conclusions: Our study suggests a strong association between hypernatremia and adverse outcomes in patients with CAP. Further studies are needed to validate our score in clinical practice.

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Hyponatremia prolongs hospital stay and hypernatremia better predicts mortality than hyponatremia in hospitalized patients with community-acquired pneumonia

Cited by 17 publications

References 17 publications

Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis

Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis

What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals

Hypernatremia and risk of death in patients hospitalized for community acquired pneumonia: findings from the FADOI-ICECAP study

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