Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis

Ravioli, Svenja; Gygli, Rebecca; Funk, Georg‐Christian; Exadaktylos, Aristomenis K.; Lindner, Gregor

doi:10.1016/j.ejim.2020.12.003

Cited by 20 publications

(20 citation statements)

References 25 publications

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“…Our cohort study observed a typical U-shaped correlation between serum sodium levels and mortality in critically ill patients with comorbid COPD. Our findings were consistent with the results of studies showing that both hyponatremia and hypernatremia were significantly associated with poor prognosis and greater risk of mortality, including community-acquired pneumonia, 32 coronavirus disease 2019 (COVID-19), 33 , 34 cirrhosis, 35 chronic kidney disease (CKD) 36 and severe burn injury. 37 In the subgroup analysis of our study, we found that hypernatremia is a more important predictor of poor prognosis in critically ill patients with comorbid COPD among older people compared with hyponatremia.…”

Section: Discussionsupporting

confidence: 91%

Association Between Serum Sodium and Long-Term Mortality in Critically Ill Patients with Comorbid Chronic Obstructive Pulmonary Disease: Analysis from the MIMIC-IV Database

Fan¹,

Sun²,

Jia³

et al. 2022

COPD

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Purpose The purpose of our study was to investigate the relationship between serum sodium levels and 1-year and 3-year mortality in critically ill patients with comorbid chronic obstructive pulmonary disease using real-world data. Methods The data of this study were collected from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. First of all, we used the Kaplan–Meier curves and multivariable Cox regression analyses to measure the relationship between serum sodium levels and 1-year and 3-year mortality for critically ill patients with comorbid COPD. Next, a restricted cubic spline was used to analyze non-parametrically the relationship between mortality and serum sodium as a continuous variable. In addition, we also analyzed the mortality of different subgroups. Results A total of 5540 eligible subjects were extracted. Compared to normal serum sodium levels, adjusted multivariable Cox regression analysis confirmed that hyponatremia and hypernatremia were still significantly associated with 1-year mortality (HR = 1.551, 95% CI = 1.333~1.805, P<0.001; HR = 1.683, 95% CI = 1.317~2.151, P<0.001, respectively) and 3-year mortality (HR = 1.507, 95% CI = 1.302~1.744, P<0.001; HR = 1.612, 95% CI = 1.269~2.048, P<0.001, respectively). In patients with or without adjustment variables, there was an obvious U-shaped non-linear relationship between serum sodium levels and 1-year and 3-year mortality with a reference level of 139 mmol/L, which indicated that patients in both hyponatremia and hypernatremia had higher mortality than normal serum sodium levels. Conclusion This study showed that both hyponatremia and hypernatremia were related to increased 1-year and 3-year mortality in critically ill patients with comorbid COPD, which provides a new reference for the control strategy of correcting serum sodium levels.

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Section: Discussionsupporting

confidence: 91%

Association Between Serum Sodium and Long-Term Mortality in Critically Ill Patients with Comorbid Chronic Obstructive Pulmonary Disease: Analysis from the MIMIC-IV Database

Fan¹,

Sun²,

Jia³

et al. 2022

COPD

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“…However, we found no significant Increase of hazard ratio for one unit increase of the variable difference in proportion of heart failure patients according to readmission status, and the risk of readmission among patients treated with diuretics was unchanged in an analysis of patients without heart failure. Another study [29] on sodium and potassium disorders in patients with community-acquired pneumonia found that use of diuretics was an independent predictor for 30-day readmission, although this study has no data on whether these patients had underlying heart failure. We cannot conclude from our data whether diuretic treatment has a causal effect on readmission, and if specific types of diuretics are associated with higher risk of readmission compared to others.…”

Section: Predictors For Readmissionmentioning

confidence: 85%

“…This is not described in previous studies of sepsis. However, diuretic treatment as a predictor for readmission and hospitalization in general has previously been described [25][26][27][28][29]. Diuretics are commonly prescribed for patients with heart failure and treatment with diuretics has been found to be a strong predictor for readmission among patients with heart failure [28].…”

Section: Predictors For Readmissionmentioning

confidence: 99%

Independent predictors for 90-day readmission of emergency department patients admitted with sepsis: a prospective cohort study

et al. 2021

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Background The primary objective of our study was to examine predictors for readmission in a prospective cohort of sepsis patients admitted to an emergency department (ED) and identified by the new Sepsis-3 criteria. Method A single-center observational population-based cohort study among all adult (≥18 years) patients with sepsis admitted to the emergency department of Slagelse Hospital during 1.10.2017–31.03.2018. Sepsis was defined as an increase in the sequential organ failure assessment (SOFA) score of ≥2. The primary outcome was 90-day readmission. We followed patients from the date of discharge from the index admission until the end of the follow-up period or until the time of readmission to hospital, emigration or death, whichever came first. We used competing-risks regression to estimate adjusted subhazard ratios (aSHRs) with 95% confidence intervals (CI) for covariates in the regression models. Results A total of 2110 patients were admitted with infections, whereas 714 (33.8%) suffered sepsis. A total of 52 patients had died during admission and were excluded leaving 662 patients (44.1% female) with a median age of 74.8 (interquartile range: 66.0–84.2) years for further analysis. A total of 237 (35,8%; 95% CI 32.1–39.6) patients were readmitted within 90 days, and 54(8.2%) had died after discharge without being readmitted. We found that a history of malignant disease (aSHR 1,61; 1.16–2.23), if previously admitted with sepsis within 1 year before the index admission (aSHR; 1.41; 1.08–1.84), and treatment with diuretics (aSHR 1.51; 1.17–1.94) were independent predictors for readmission. aSHR (1.49, 1.13–1.96) for diuretic treatment was almost unchanged after exclusion of patients with heart failure, while aSHR (1.47, 0.96–2.25) for malignant disease was slightly attenuated after exclusion of patients with metastatic tumors. Conclusions More than one third of patients admitted with sepsis, and discharged alive, were readmitted within 90 days. A history of malignant disease, if previously admitted with sepsis, and diuretic treatment were independent predictors for 90-day readmission.

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“…EHMRG contains several items that are currently adopted in the prognostication of AHF and other critical illnesses in internal medicine, such as age, systolic blood pressure, creatinine, electrolyte imbalances, and troponin increase. These markers have a defined prognostic role also in other critical illnesses, often managed outside a cardiologic departments, such as sepsis and septic shock [ 46 , 47 , 48 , 49 , 50 ], pulmonary embolism [ 51 ], and pneumonia [ 52 , 53 , 54 , 55 ]. Thus, the adoption of these items in a predictive score seems more useful for an older, more complex, and less selected population, as the one commonly observed in the ED and in Internal Medicine.…”

Section: Discussionmentioning

confidence: 99%

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

et al. 2022

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The Emergency Heart Failure Mortality Risk Grade (EHMRG) can predict short-term mortality in patients admitted for acute heart failure (AHF) in the emergency department (ED). This paper aimed to evaluate if TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can improve in-hospital death prediction in patients at moderate-to-high risk, according to EHMRG score classification. From 1 January 2018 to 30 December 2019, we retrospectively enrolled all the consecutive subjects admitted to our Internal Medicine Department for AHF from the ED. We performed bedside echocardiography within the first 24 h of admission. We evaluated EHMRG and NYHA in the ED, days of admission in Internal Medicine, and in-hospital mortality. We assessed cutoffs with ROC curve analysis and survival with Kaplan–Meier and Cox regression. We obtained a cohort of 439 subjects; 10.3% underwent in-hospital death. Patients with normal TAPSE/PASp in EHMRG Classes 4, 5a, and 5b had higher survival rates (100%, 100%, and 94.3%, respectively), while subjects with pathologic TAPSE/PASp had lower survival rates (81.8%, 78.3%, and 43.4%, respectively) (p < 0.0001, log-rank test). TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can further stratify the risk of in-hospital death evaluated by EHMRG.

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Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis

Cited by 20 publications

References 25 publications

Association Between Serum Sodium and Long-Term Mortality in Critically Ill Patients with Comorbid Chronic Obstructive Pulmonary Disease: Analysis from the MIMIC-IV Database

Association Between Serum Sodium and Long-Term Mortality in Critically Ill Patients with Comorbid Chronic Obstructive Pulmonary Disease: Analysis from the MIMIC-IV Database

Independent predictors for 90-day readmission of emergency department patients admitted with sepsis: a prospective cohort study

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

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