Association Between an Increase in Serum Sodium and In-Hospital Mortality in Critically Ill Patients.

Abstract

OBJECTIVES:

In critically ill patients, dysnatremia is common, and in these patients, in-hospital mortality is higher. It remains unknown whether changes of serum sodium after ICU admission affect mortality, especially whether normalization of mild hyponatremia improves survival.

DESIGN:

Retrospective cohort study.

SETTING:

Ten Dutch ICUs between January 2011 and April 2017.

PATIENTS:

Adult patients were included if at least one serum sodium measurement within 24 hours of ICU admission and at least one serum sodium measurement 24-48 hours after ICU admission were available.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A logistic regression model adjusted for age, sex, and Acute Physiology and Chronic Health Evaluation-IV-predicted mortality was used to assess the difference between mean of sodium measurements 24-48 hours after ICU admission and first serum sodium measurement at ICU admission (Δ48 hr-[Na]) and in-hospital mortality. In total, 36,660 patients were included for analysis. An increase in serum sodium was independently associated with a higher risk of in-hospital mortality in patients admitted with normonatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.61 [1.44-1.79], Δ48 hr-[Na] > 10 mmol/L odds ratio: 4.10 [3.20-5.24]) and hypernatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.47 [1.02-2.14], Δ48 hr-[Na] > 10 mmol/L odds ratio: 8.46 [3.31-21.64]). In patients admitted with mild hyponatremia and Δ48 hr-[Na] greater than 5 mmol/L, no significant difference in hospital mortality was found (odds ratio, 1.11 [0.99-1.25]).

CONCLUSIONS:

An increase in serum sodium in the first 48 hours of ICU admission was associated with higher in-hospital mortality in patients admitted with normonatremia and in patients admitted with hypernatremia.

• Authors: Chloe C A Grim, Fabian Termorshuizen, Robert J Bosman, Olaf L Cremer, Arend Jan Meinders, Maarten W N Nijsten, Peter Pickkers, Angelique M E de Man, Marcus J Schultz, Peter van Vliet, Joachim D Weigel, Hendrik J F Helmerhorst, Nicolette F de Keizer, Evert de Jonge
• Journal: Critical care medicine (Crit Care Med) Vol. 49 Issue 12 Pg. 2070-2079 (12 01 2021) ISSN: 1530-0293 [Electronic] United States
• PMID: 34166287 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Chemical References

• Sodium

Topics

• Adult
• Aged
• Cohort Studies
• Correlation of Data
• Critical Illness (mortality)
• Female
• Hospital Mortality (trends)
• Humans
• Hypernatremia (blood, complications, mortality)
• Intensive Care Units (organization & administration, statistics & numerical data)
• Logistic Models
• Male
• Middle Aged
• Netherlands (epidemiology)
• Retrospective Studies
• Sodium (analysis, blood)