Mortality rates are lower in SIAD, than in hypervolaemic or hypovolaemic hyponatraemia: Results of a prospective observational study

Cuesta, Martín; Garrahy, Aoife; Slattery, David; Gupta, Saket; Hannon, Anne Marie; McGurren, Karen; Sherlock, Mark; Tormey, William; Thompson, Christopher J.

doi:10.1111/cen.13388

Cited by 40 publications

(39 citation statements)

References 39 publications

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“…The commonest cause of HEN in this study was cardiac failure, and as the Charlson Comorbidity Index was significantly higher in this group the excess mortality was likely to have reflected the presence of pulmonary oedema, or left ventricular dysfunction, rather than associated hyponatraemia. Our data emphasise the poorer prognosis associated pneumonia complicated by HEN, which is in concordance with our data from all‐cause hyponatraemia . Nevertheless, this statement should be taken cautiously as it is based only in 13 patients with pneumonia and HEN; higher number of patients would have left to more confident conclusions.…”

Section: Discussionsupporting

confidence: 89%

“…Our data emphasise the poorer prognosis associated pneumonia complicated by HEN, which is in concordance with our data from all-cause hyponatraemia. 24 Nevertheless, this statement should be taken cautiously as it is based only in 13 patients with pneumonia and HEN; higher number of patients would have left to more confident conclusions.…”

Section: Hyponatraemia and Mortalitymentioning

confidence: 99%

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Hyponatraemia in patients with community‐acquired pneumonia; prevalence and aetiology, and natural history of SIAD

Cuesta

Slattery

Goulden

et al. 2019

Clinical Endocrinology

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Summary Objective Hyponatraemia is common in community‐acquired pneumonia (CAP) and is associated with increased mortality. The mechanism of hyponatraemia in CAP is not completely understood and treatment is therefore ill‐defined. We aimed to define the causation of hyponatraemia in CAP. Design Prospective, single‐centre, observational study of all patients with CAP and hyponatraemia (≤ 130 mmol/L) during a 9‐month period. Patients The prevalence of each subtype of hyponatraemia, and the associated mortality, was determined in 143 admissions with CAP (Study 1). A sub‐cohort of patients with SIAD (n = 10) was prospectively followed, to document the natural history of SIAD associated with CAP (Study 2). Measurements In Study 2, blood and urine were collected on day 1, 3, 5 and 7 following admission for measurement of plasma vasopressin, sodium, osmolality and urine osmolality. Results In study 1, 143/1723(8.3%) of CAP patients had hyponatraemia (≤130 mmol/L). About 66 had SIAD (46%), 60(42%) had hypovolaemic hyponatraemia (HON), 13(9%) had hypervolaemic hyponatraemia (HEN) and 4(3%) patients had hyponatraemia due to glucocorticoid hormone deficiency. Mortality was higher in the HEN than in the HON, SIAD or normonatraemic groups (P < 0.01). In Study 2, plasma sodium concentration normalized in 8/10 (80%) by day 7. Two patients with persistent hyponatraemia were discovered to have underlying bronchiectasis. Conclusions Hyponatraemia in CAP is most commonly secondary to SIAD or hypovolaemia. HEN is less common, but has worse prognosis. Prospective observation demonstrates that in SIAD, plasma AVP and sodium concentrations normalize with antimicrobials; failure of reversal of suggests underlying lung disease, such as bronchiectasis.

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Section: Discussionsupporting

confidence: 89%

Section: Hyponatraemia and Mortalitymentioning

confidence: 99%

Hyponatraemia in patients with community‐acquired pneumonia; prevalence and aetiology, and natural history of SIAD

Cuesta

Slattery

Goulden

et al. 2019

Clinical Endocrinology

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“…It is divided into euvolemic, hypovolemic, and hypervolemic hyponatremia, each of which is treated differently 23,24 . The syndrome of inappropriate antidiuresis (SIAD) is the commonest cause of hyponatremia 22,25 .…”

Section: Hyponatremiamentioning

confidence: 99%

“…-As the mortality from hypovolaemic hyponatraemia is higher than that of SIAD 25 , the temptation is, that if it does occur in COVID-19 patients, to respond with intravenous fluid resuscitation. However, in severely ill COVID-19 patients, clinical experience dictates that caution should be exercised in the rate of intravenous fluid administration, because of the risk of precipitating pulmonary oedema.…”

Section: What To Look At If Patients With Hyponatremia Are Admitted Tmentioning

confidence: 99%

ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of diabetes insipidus and hyponatraemia

Christ‐Crain

Hoorn

Sherlock

et al. 2020

European Journal of Endocrinology

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Running title: DI and hypontraemia in times of COVID-19Word count abstract: 210 words Word count: 2'500 Number of tables: 2This manuscript is part of a commissioned series of urgent clinical guidance documents on the management of endocrine conditions in the time of COVID-19. This clinical guidance document underwent expedited open peer review by Joe Verbalis (USA), Jens Otto Jørgensen (Denmark), Stefan Bilz (Switzerland) and Georg Lindner (Switzerland).Disclaimer: Due to the emerging nature of the COVID-19 crisis this document is not based on extensive systematic review or meta-analysis, but on rapid expert consensus. The document should be considered as guidance only; it is not intended to determine an absolute standard of medical care. Healthcare staff need to consider individual circumstances when devising the management plan for a specific patient. AbstractCOVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatremia.The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to

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“…As randomized controlled trials are still lacking to assess the impact of hyponatremia and its treatment on clinical outcomes, a considerable number of retrospective studies have investigated its association ( 1 , 4-8 ). Although most of these analyses were based on adjusted (including deidentified demographics, comorbidities, and severity indices) statistical models comparing patients with and without hyponatremia, baseline characteristics varied significantly.…”

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confidence: 99%

Risk of Adverse Clinical Outcomes in Hyponatremic Adult Patients Hospitalized for Acute Medical Conditions: A Population-Based Cohort Study

Kutz

Ebrahimi

Aghlmandi

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Hyponatremia has been associated with excess long-term morbidity and mortality. However, effects during hospitalization are poorly studied. Objective To examine the association of hyponatremia with the risk of in-hospital mortality, 30-day readmission, and other short-term adverse events among medical inpatients. Design Population-based cohort study using a Swiss claims database from January 2012 to December 2017 Setting Medical inpatients Patients Hyponatremic patients were 1:1 propensity-score matched with normonatremic medical inpatients. Main outcome measure The primary outcome was a composite of all-cause in-hospital mortality and 30-day hospital readmission. Secondary outcomes were intensive care unit (ICU) admission, intubation rate, length-of-hospital stay (LOS), and patient disposition after discharge. Results After matching, 94`352 patients were included in the cohort. Among 47`176 patients with hyponatremia, 8`383 (17.8%) reached the primary outcome compared with 7`994 (17.0%) in the matched control group (OR 1.06 [95%CI, 1.02 to 1.10], p=0.001). Hyponatremic patients were more likely to be admitted to ICU (OR 1.43 [95%CI, 1.37 to 1.50], p&0.001), faced a 56% increase in prolonged LOS (95%CI 1.52 to 1.60, p&0.001), and were admitted more often to a post-acute care facility (OR 1.38 [95%CI 1.34 to 1.42, p&0.001). Of note, patients with the syndrome of inappropriate antidiuresis (SIAD) had lower in-hospital mortality (OR 0.67 [95%CI, 0.56 to 0.80], p&0.001) as compared with matched normonatremic controls. Conclusion In this study, hyponatremia was associated with increased risk of short-term adverse events, primarily driven by higher readmission rates, which was consistent among all outcomes except for decreased in-hospital mortality in SIAD patients.

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Mortality rates are lower in SIAD, than in hypervolaemic or hypovolaemic hyponatraemia: Results of a prospective observational study

Cited by 40 publications

References 39 publications

Hyponatraemia in patients with community‐acquired pneumonia; prevalence and aetiology, and natural history of SIAD

Hyponatraemia in patients with community‐acquired pneumonia; prevalence and aetiology, and natural history of SIAD

ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of diabetes insipidus and hyponatraemia

Risk of Adverse Clinical Outcomes in Hyponatremic Adult Patients Hospitalized for Acute Medical Conditions: A Population-Based Cohort Study

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