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Achinger SG, Ayus JC, Kumar A, Tsalatsanis A. Thiazide-Associated Hyponatremia and Mortality Risk: A Cohort Study. Kidney Med 2025; 7:100941. [PMID: 39866296 PMCID: PMC11759562 DOI: 10.1016/j.xkme.2024.100941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2025] Open
Abstract
Rationale & Objective There are likely over 42 million patients with hypertension taking thiazides in the United States and many more worldwide. Hyponatremia is a common complication of thiazide therapy. It is not currently known if thiazide-associated hyponatremia is also associated with increased mortality. The objective of this study was to determine if outpatients who start thiazide diuretic treatment and develop early hyponatremia are at increased risk of mortality when compared with those who do not develop hyponatremia after starting a thiazide. Study Design A retrospective cohort study. Setting & Participants This study used data from the TriNetX federated health research network comprising deidentified electronic medical records of ∼93 million patients from 76 health care organizations located primarily in the United States. The study population was adult patients 40-90 years old, with essential hypertension and who started on a thiazide diuretic between January 1, 2010, and December 31, 2021. The patients were then subdivided into a hyponatremia cohort and a control cohort. 22,057 patients met the inclusion criteria for the hyponatremia cohort, and 234,466 patients met the inclusion criteria for the control cohort. After propensity score matching, 22,052 remained in both cohorts. The primary outcome is one-year mortality. Exposure The hyponatremia cohort developed early hyponatremia defined as a serum sodium ≤ 135 mmol/L within 6 months after initiation of thiazide versus a control that had a serum sodium 136-144 mmol/L after initiation of thiazide. Outcomes Primary outcome is mortality. Secondary outcomes include development of sepsis, pneumonia, urinary tract infection, cellulitis, myocardial infarction, stroke, congestive heart failure, ataxia, fall, and hip fracture. Analytical Approach The design is a retrospective cohort study, propensity score matched. Results Patients in the hyponatremia cohort had a higher hazard of mortality than patients in control, HR 1.96 (95% CI, 1.72-2.28; P < 0.001). In addition, patients in the hyponatremia cohort had higher hazard of developing sepsis, pneumonia, urinary tract infection, cellulitis, myocardial infarction, stroke, congestive heart failure, ataxia, and hip fracture. Limitations The study had a retrospective design. Conclusions Patients who develop early hyponatremia (serum sodium ≤ 135 mmol/L) following initiation of a thiazide diuretic have a higher risk of mortality when compared with those who do not develop hyponatremia after initiation of a thiazide diuretic.
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Affiliation(s)
- Steven G. Achinger
- Department of Nephrology and Hypertension, University of South Florida, Tampa, FL
- Department of Nephrology, Watson Clinic, LLP, Lakeland, FL
| | - Juan Carlos Ayus
- Department of Nephrology, University of California, Irvine, Irvine, CA
| | - Ambuj Kumar
- Department of Internal Medicine, Research Methodology and Biostatistics Core, Office of Research, Morsani College of Medicine, University of South Florida Health, Tampa, FL
| | - Athanasios Tsalatsanis
- Department of Internal Medicine, Research Methodology and Biostatistics Core, Office of Research, Morsani College of Medicine, University of South Florida Health, Tampa, FL
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Lee S, Kim S, Koh G, Ahn H. Identification of Time-Series Pattern Marker in Its Application to Mortality Analysis of Pneumonia Patients in Intensive Care Unit. J Pers Med 2024; 14:812. [PMID: 39202004 PMCID: PMC11355743 DOI: 10.3390/jpm14080812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024] Open
Abstract
Electronic Health Records (EHRs) are a significant source of big data used to track health variables over time. The analysis of EHR data can uncover medical markers or risk factors, aiding in the diagnosis and monitoring of diseases. We introduce a novel method for identifying markers with various temporal trend patterns, including monotonic and fluctuating trends, using machine learning models such as Long Short-Term Memory (LSTM). By applying our method to pneumonia patients in the intensive care unit using the MIMIC-III dataset, we identified markers exhibiting both monotonic and fluctuating trends. Specifically, monotonic markers such as red cell distribution width, urea nitrogen, creatinine, calcium, morphine sulfate, bicarbonate, sodium, troponin T, albumin, and prothrombin time were more frequently observed in the mortality group compared to the recovery group throughout the 10-day period before discharge. Conversely, fluctuating trend markers such as dextrose in sterile water, polystyrene sulfonate, free calcium, and glucose were more frequently observed in the mortality group as the discharge date approached. Our study presents a method for detecting time-series pattern markers in EHR data that respond differently according to disease progression. These markers can contribute to monitoring disease progression and enable stage-specific treatment, thereby advancing precision medicine.
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Affiliation(s)
- Suhyeon Lee
- Division of Data Science, The University of Suwon, Hwaseong-si 16419, Republic of Korea; (S.L.); (S.K.); (G.K.)
- DS&ML Center, The University of Suwon, Hwaseong-si 16419, Republic of Korea
| | - Suhyun Kim
- Division of Data Science, The University of Suwon, Hwaseong-si 16419, Republic of Korea; (S.L.); (S.K.); (G.K.)
- DS&ML Center, The University of Suwon, Hwaseong-si 16419, Republic of Korea
| | - Gayoun Koh
- Division of Data Science, The University of Suwon, Hwaseong-si 16419, Republic of Korea; (S.L.); (S.K.); (G.K.)
- DS&ML Center, The University of Suwon, Hwaseong-si 16419, Republic of Korea
| | - Hongryul Ahn
- Division of Data Science, The University of Suwon, Hwaseong-si 16419, Republic of Korea; (S.L.); (S.K.); (G.K.)
- DS&ML Center, The University of Suwon, Hwaseong-si 16419, Republic of Korea
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Kwon S, Kim H, Lee J, Shin J, Kim SH, Hwang JH. Thiazide-associated hyponatremia in arterial hypertension patients: A nationwide population-based cohort study. J Evid Based Med 2024; 17:296-306. [PMID: 38566339 DOI: 10.1111/jebm.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Thiazides are the first-line treatment for hypertension, however, they have been associated with hospitalizations for thiazide-associated hyponatremia (TAH). The aim of this study was to evaluate the risk of TAH and other drug-associated hyponatremia in a Korean population. METHODS The study used big data from the National Health Insurance Sharing Service of 1,943,345 adults treated for hypertension from January 2014 to December 2016. The participants were divided into two groups based on the use of thiazides. Cox proportional hazard models were used to identify independent risk factors for the occurrence of hyponatremia. RESULTS The study found that hyponatremia-related hospitalizations were significantly higher in the thiazide group than the control group (2.19% vs. 1.45%). The risk increased further with concurrent use of other diuretics or desmopressin, and thiazide+spironolactone+desmopressin and hospitalization risk further increased (4.0 and 6.9 times). Multivariate analysis showed that hyponatremia occurrence increased with age, diabetes mellitus, depression, and thiazide use (hazard ratio = 1.436, p < 0.001). The thiazide group had better 6-year overall survival than the control group but had more fractures and hyponatremia. CONCLUSIONS Thiazide use is associated with an increased risk of hyponatremia and related complications. However, the mortality rate decreased in those who received thiazides, suggesting that thiazide use itself is not harmful and may help decrease complications and improve prognosis with proper, cautious use in high-risk patients.
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Affiliation(s)
- Soie Kwon
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hasung Kim
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Jungho Shin
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Su Hyun Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi, Republic of Korea
| | - Jin Ho Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Gurbuz M, Acehan S, Satar S, Gulen M, Sevdımbas S, Ince C, Onan E. Mortality predictors of patients diagnosed with severe hyponatremia in the emergency department. Ir J Med Sci 2024; 193:1561-1572. [PMID: 38291136 DOI: 10.1007/s11845-024-03615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE To determine the factors affecting mortality as a result of the analysis of the demographic and clinical characteristics and laboratory parameters of patients whose serum Na value was determined to be 125 mEq/L or below at the time of admission to the emergency department (ED). METHOD Patients over 18 years of age who admitted to the ED of a tertiary hospital between September 2021 and September 2022 and whose serum sodium level was determined to be 125 mEq/L and below were included in the study. Demographic and clinical characteristics, admission complaints, medications used, Charles comorbidity index (CCI), laboratory parameters, and outcomes of the patients included in the study were recorded in the data form. RESULTS Three hundred ninety-nine patients were included in the study. When the 30-day mortality of the patients is examined, the mortality rate was found to be 21.6%. In the analyses performed for the predictive power of laboratory parameters for mortality, it was determined that the highest predictive power among the predictive values determined by the area under the curve (AUC) was the albumin level (AUC 0.801, 95% CI 0.753-0.849, p < 0.001). In the binary logistic regression analysis, urea and albumin were independent predictors of 30-day mortality. CONCLUSION According to study data, albumin and urea levels are independent predictors of 30-day mortality in patients diagnosed with severe hyponatremia in the emergency department.
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Affiliation(s)
- Mesut Gurbuz
- Department of Emergency Medicine, Ministry of Health Kilis Prof. Dr. Alaeddin Yavasca Hospital, Kilis, Turkey
| | - Selen Acehan
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey.
| | - Salim Satar
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Muge Gulen
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Sarper Sevdımbas
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Cagdas Ince
- Department of Emergency Medicine, Ministry of Health Bursa Karacabey Hospital, Bursa, Turkey
| | - Engin Onan
- Department of Nephrology, Adana Baskent University, Adana, Turkey
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Terlecki M, Kocowska-Trytko M, Kurzyca A, Pavlinec C, Zając M, Rusinek J, Lis P, Bednarski A, Wojciechowska W, Stolarz-Skrzypek K, Rajzer M. The sodium-chloride difference: A marker of prognosis in patients with acute myocardial infarction. Eur J Clin Invest 2024; 54:e14157. [PMID: 38226439 DOI: 10.1111/eci.14157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND The difference between serum sodium and chloride ion concentrations (SCD) may be considered as a surrogate of a strong ion difference and may help to identify patients with a worse prognosis. We aimed to assess SCD as an early prognostic marker among patients with myocardial infarction. METHODS Data of 594 consecutive patients with acute myocardial infarction treated with PCI (44.9% STEMI patients; 70.7% males) was analysed for SCD in relation to their 30-day mortality. A restricted cubic spline regression model was used to study the relationship between mortality and SCD. Cox regression models were used to assess the association between SCD and the mortality risk. RESULTS Patients with Killip class ≥3 had lower SCD values in comparison to patients with Killip class ≤2: (32.0 [30.0-34.0] vs. 33.0 [31.0-36.0], p = .006). The overall 30-day mortality was 7.7% (n = 46). There was a significant difference in SCD values between survivors and non-survivors groups of patients (median (IQR): (33.0 [31.0-36.0] vs. 31.5 [28.0-34.0] (mmol/L), p = .002). The restricted cubic splines model confirmed a non-linear association between SCD and mortality. Patients with SCD <30 mmol/L (in comparison to SCD ≥30 mmol/L) had an increased mortality risk (unadjusted HR 2.92, 95% CI 1.59-5.36, p = .001; and an adjusted HR 2.30, 95% CI 1.02-5.19, p = .04). CONCLUSIONS Low SCD on admission is associated with an increased risk of 30-day mortality in patients with acute myocardial infarction treated with PCI and may serve as a useful prognostic marker for these patients.
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Affiliation(s)
- Michał Terlecki
- Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Kraków, Poland
| | - Maryla Kocowska-Trytko
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Kurzyca
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Zając
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- Student's Scientific Group in the 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Rusinek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- Student's Scientific Group in the 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Lis
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Bednarski
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
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Pande V, Jadhav R, Ilyaz M, Mane S, Dua J. Dyselectrolytemia in Children With Severe Pneumonia: A Prospective Study. Cureus 2024; 16:e53940. [PMID: 38468998 PMCID: PMC10925843 DOI: 10.7759/cureus.53940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
Background Pneumonia is a condition characterized by inflammation of the lung parenchyma. It is one of the leading causes of mortality in children below five years of age. While predominantly prevalent in developing countries, it is also associated with significant healthcare-associated costs in developed countries. Among the many risk factors for childhood pneumonia, incomplete immunization, nonexclusive breastfeeding for less than six months, delayed weaning, poor household air quality, malnutrition, and low birth weight are the most commonly found. Electrolyte disturbances, also known as dyselectrolytemia, have been associated with a broad spectrum of acute infections, including pneumonia, particularly hyponatremia. It occurs in the majority of community-acquired pneumonia. Hyper- and hypokalemia are less frequently occurring electrolyte disturbances. Electrolyte disturbances are due to impairment of the intrarenal mechanism of urine dilution due to extracellular fluid volume depletion and inappropriate secretion of antidiuretic hormone. The central nervous system is imminently affected by acute hyponatremia. This condition frequently culminates in cerebral edema, a result of the rapid fluid shift, and causes sudden fatality. Aim of the study This study aims to study dyselectrolytemia in children with severe pneumonia. Objectives The study objectives are to assess dyselectrolytemia in children with severe pneumonia and to correlate dyselectrolytemia with morbidity and hospital stay. Methodology This prospective study was conducted on 80 children in the age group of two months up to five years who visited our tertiary care center and had severe pneumonia. We evaluated the extent of dyselectrolytemia in our study population by analyzing the frequency correlation of different kinds of electrolyte imbalances. We also analyzed the correlation between morbidity and hospital stay. Results Out of 80 children in this study with severe pneumonia, 47 (59%) had electrolyte imbalance. Among the patients with electrolyte imbalance, 31 (39%) patients had hyponatremia followed by hypokalemia in 12 (15%) patients, hypernatremia in 3 (4%) patients, and hyperkalemia in 1 (1%) patient. Among the 17 (21%) children with pneumonia requiring ICU admission, 16 (94%) had dyselectrolytemia and 4 (24%) experienced fatal outcomes. Conclusions The majority of the children who were admitted to the ICU had severe pneumonia along with electrolyte imbalance. This necessitates the monitoring of the electrolyte and nutritional status of the patients with pneumonia. Providing proper nutrition advice for children with pneumonia may reduce morbidity and mortality. Early detection and treatment of electrolyte imbalances in pneumonia cases can decrease prolonged hospital stays, ICU admissions, and the need for mechanical ventilation, ultimately contributing to a reduction in morbidity and mortality.
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Affiliation(s)
- Vineeta Pande
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Renuka Jadhav
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Md Ilyaz
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Shailaja Mane
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Jasleen Dua
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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Biagetti B, Sánchez-Montalvá A, Puig-Perez A, Campos-Varela I, Pilia MF, Anderssen-Nordahl E, González-Sans D, Miarons M, Simó R. Hyponatremia after COVID-19 is frequent in the first year and increases re-admissions. Sci Rep 2024; 14:595. [PMID: 38182711 PMCID: PMC10770325 DOI: 10.1038/s41598-023-50970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024] Open
Abstract
Hyponatremia on admission has been related to worse outcomes in patients with COVID-19 infection. However, little is known about the frequency and the associated risk factors of hyponatremia after COVID-19 discharge. We performed an observational 24-month follow-up study of patients admitted during the first COVID-19 wave. Kaplan-Meier curves and Cox proportional hazard models were used to assess the main variables in predicting hyponatremia on follow-up (HYPO-FU). A total of 161 out of 683 (24.4%) developed HYPO-FU. The group with HYPO-FU comprised of more men [(62.3%) vs. (49.2%); p < 0.01], older [65.6 ± 18.2 vs. 60.3 ± 17.0; p < 0.01] and more frequently re-admitted [(16.2%) vs. (3.8%); p < 0.01). The rate of HYPO-FU was higher in the first year 23.6 per 100 individuals per year. After Cox regression analysis, the independent risk factors of HYPO-FU were diabetes [OR 2.12, IC 95% (1.48-3.04)], hypertension [OR 2.18, IC 95% (1.53-3.12)], heart failure [OR 3.34, IC 95% (1.72-6.48)] and invasive ventilation support requirement [OR: 2.38, IC 95% (1.63-3.50)]. To conclude, HYPO-FU was frequent in the first year after COVID-19 infection, and the risk was higher in older men with comorbidities, increasing rehospitalisation. Further studies aimed at evaluating the beneficial effects of correcting hyponatremia in these patients are warranted.
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Affiliation(s)
- Betina Biagetti
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Adrián Sánchez-Montalvá
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Global Health Program from the Catalan Health Institute (PROSICS), Universitat Autònoma de Barcelona, Barcelona, Spain
- Mycobacterial Infection Study Group from the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIM-SEIMC), Barcelona, Spain
- Infectious Diseases Netword Biomedical Research Center (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Albert Puig-Perez
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Isabel Campos-Varela
- Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - María Florencia Pilia
- Pneumology Department, Vall d'Hebron University Hospital, Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Emilie Anderssen-Nordahl
- Department of Clinical Pharmacology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Didac González-Sans
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rafael Simó
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain.
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Şimşek Veske N, Tural Onur S, Abalı H, Kara K, Tokgöz Akyıl F, Sökücü SN, Gönenç Ortaköylü M. Differentiating Pulmonary Tuberculosis from Bacterial Pneumonia: The Role of Inflammatory and Other Biomarkers. ISTANBUL MEDICAL JOURNAL 2023; 24:305-311. [DOI: 10.4274/imj.galenos.2023.97254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024] Open
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Regolisti G, Rebora P, Occhino G, Lieti G, Molon G, Maloberti A, Algeri M, Giannattasio C, Valsecchi MG, Genovesi S. Elevated Serum Urea-to-Creatinine Ratio and In-Hospital Death in Patients with Hyponatremia Hospitalized for COVID-19. Biomedicines 2023; 11:1555. [PMID: 37371650 DOI: 10.3390/biomedicines11061555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Hyponatremia is associated with adverse outcomes in hospitalized patients. An elevated value of the serum urea-to-creatinine ratio (UCR) has been proposed as a proxy of hypovolemia. The aim of this study was to investigate the relationship between the UCR and in-hospital death in patients hospitalized with COVID-19 and hyponatremia. We studied 258 patients admitted for COVID-19 between January 2020 and May 2021 with serum sodium at < 135 mmol/L. The primary end-point was all-cause mortality. A 5-unit increase in the serum UCR during hospital stays was associated with an 8% increase in the hazard of all-cause death (HR = 1.08, 95% CI: 1.03-1.14, p = 0.001) after adjusting for potential confounders. In patients with a UCR > 40 at baseline, a > 10 mmol/L increase in serum sodium values within the first week of hospitalization was associated with higher odds of in-hospital death (OR = 2.93, 95% CI: 1.03-8.36, p = 0.044) compared to patients who experienced a < 10 mmol/L change. This was not observed in patients with a UCR < 40. Hypovolemia developing during hospital stays in COVID-19 patients with hyponatremia detected at hospital admission bears an adverse prognostic impact. Moreover, in hypovolemic patients, a > 10 mmol/L increase in serum sodium within the first week of hospital stays may further worsen the in-hospital prognosis.
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Affiliation(s)
- Giuseppe Regolisti
- Clinica e Immunologia Medica, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Giuseppe Occhino
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Giulia Lieti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Giulio Molon
- Cardiology Department, Istituto Ricovero Cura Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Cardiology 4, Cardio Center, ASST-GOM Niguarda, Niguarda Hospital, 20162 Milan, Italy
| | - Michela Algeri
- Cardiology 4, Cardio Center, ASST-GOM Niguarda, Niguarda Hospital, 20162 Milan, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Cardiology 4, Cardio Center, ASST-GOM Niguarda, Niguarda Hospital, 20162 Milan, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Simonetta Genovesi
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), 20135 Milan, Italy
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Du R, Feng Y, Wang Y, Huang J, Tao Y, Mao H. Metagenomic next-generation sequencing confirms the diagnosis of Legionella pneumonia with rhabdomyolysis and acute kidney injury in a limited resource area: a case report and review. Front Public Health 2023; 11:1145733. [PMID: 37228720 PMCID: PMC10205016 DOI: 10.3389/fpubh.2023.1145733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
Background Legionella pneumonia, rhabdomyolysis, and acute kidney injury are called the Legionella triad, which is rare and associated with a poor outcome and even death. Early diagnosis and timely treatment are essential for these patients. Case presentation A 63-year-old man with cough, fever, and fatigue was initially misdiagnosed with common bacterial infection and given beta-lactam monotherapy but failed to respond to it. Conventional methods, including the first Legionella antibody test, sputum smear, and culture of sputum, blood, and bronchoalveolar lavage fluid (BALF) were negative. He was ultimately diagnosed with a severe infection of Legionella pneumophila by metagenomics next-generation sequencing (mNGS). This patient, who had multisystem involvement and manifested with the rare triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury, finally improved after combined treatment with moxifloxacin, continuous renal replacement therapy, and liver protection therapy. Conclusion Our results showed the necessity of early diagnosis of pathogens in severe patients, especially in Legionnaires' disease, who manifested with the triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury. mNGS may be a useful tool for Legionnaires' disease in limited resource areas where urine antigen tests are not available.
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Affiliation(s)
- Rao Du
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yinhe Feng
- Department of Respiratory and Critical Care Medicine, Deyang People's Hospital, Affiliated Hospital of Chengdu College of Medicine, Deyang, China
| | - Yubin Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jifeng Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yuhan Tao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Mao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Chan GCK, Wong CK, So BYF, Ng JKC, Lui GCY, Szeto CC, Hung IFN, Tse HF, Tang SCW, Chan TM, Chow KM, Yap DYH. Epidemiology and outcomes of hyponatremia in patients with COVID-19-A territory-wide study in Hong Kong. Front Med (Lausanne) 2023; 9:1096165. [PMID: 36714113 PMCID: PMC9874105 DOI: 10.3389/fmed.2022.1096165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
Background Hyponatremia is common in COVID-19, but its epidemiology and impact on clinical outcomes in relation to different variants, especially the Omicron variant, requires further clarification. Methods This was a territory-wide retrospective study to investigate the epidemiology and outcomes of COVID-19 patients with hyponatremia from January 1, 2020 to March 31, 2022 in Hong Kong. The primary outcome was 30-day mortality of patients with COVID-19 and hyponatremia at presentation. Secondary outcomes included rate of hospitalization, intensive care unit (ICU) hospitalization, overall duration of hospitalization, and duration of ICU hospitalization. Results A total of 53,415 COVID-19 patients were included for analysis, of which 14,545 (27.2%) had hyponatremia at presentation. 9813 (67.5%), 2821 (19.4%), and 1911 (13.1%) had mild (130 to <135 mmol/L), moderate (125 to <130 mmol/L), and severe hyponatremia (<125 mmol/L) at presentation respectively. Age, male sex, diabetes, active malignancy, white cell count, serum creatinine, hypoalbuminemia, C-reactive protein, and viral loads were independent predictors for hyponatremia in COVID-19 patients (P < 0.001, for all). Hyponatremic patients had increased 30-day mortality (9.7 vs. 5.7%, P < 0.001), prolonged hospitalization (11.9 ± 15.1 days vs. 11.5 ± 12.1 days, P < 0.001), and more ICU admissions (7.0% vs. 3.3%, P < 0.001). Patients diagnosed during the "fifth wave" Omicron BA.2 outbreak had 2.29-fold risk (95% CI 2.02-2.59, P < 0.001) of presenting with hyponatremia compared to other waves. Conclusion Hyponatremia is common among COVID-19 patients, and may serve as a prognostic indicator for unfavorable outcomes and increased healthcare utilization in the evolving COVID-19 outbreak.
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Affiliation(s)
- Gordon Chun Kau Chan
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chun Ka Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Benjamin Y. F. So
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jack Kit Chung Ng
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Grace Chung Yan Lui
- Division of Infectious Diseases, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Cheuk Chun Szeto
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ivan Fan Ngai Hung
- Division of Infectious Diseases, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Hung Fat Tse
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Sydney C. W. Tang
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Tak Mao Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kai Ming Chow
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,Kai Ming Chow,
| | - Desmond Y. H. Yap
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,*Correspondence: Desmond Y. H. Yap,
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12
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Khidir RJY, Ibrahim BAY, Adam MHM, Hassan RME, Fedail ASS, Abdulhamid RO, Mohamed SOO. Prevalence and outcomes of hyponatremia among COVID-19 patients: A systematic review and meta-analysis. Int J Health Sci (Qassim) 2022; 16:69-84. [PMID: 36101848 PMCID: PMC9441642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives On March 2020, the WHO declared coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is associated with various clinical syndromes, with electrolytes imbalances involved. This review aims to quantify the prevalence and outcomes of hyponatremia among COVID-19 patients, as well as to review the underlying pathophysiological mechanisms of hyponatremia among these patients. Methods Using Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, we conducted a systematic literature search using the electronic databases of Google Scholar, MEDLINE (PubMed), WHO Virtual Health Library, and ScienceDirect, without limitations regarding gender, geographical area, race or publication date, up until December 13, 2021. Primary outcomes measured were mortality, intensive care unit (ICU) admission, assisted ventilation need, and length of hospital stay (LOS). Secondary outcome was the mechanism underlying hyponatremia among COVID-19 patients. Results From a total of 52 included studies, 23 underwent quantitative analysis. For the primary outcomes; proportions, odds ratios (OR), and standardized mean difference (SMD) were calculated using random effects model. The prevalence of hyponatremia was found to be 25.8%. Hyponatremia was found to be significantly associated with increased odds for mortality (OR = 1.97[95% CI, 1.50-2.59]), ICU admission (OR = 1.91 [95% CI, 1.56-2.35]), assisted ventilation need (OR = 2.04 [95% CI, 1.73-2.38]), and with increased LOS (SMD of 5.74 h [95% CI, 0.092-0.385]). Regarding the mechanisms underlying hyponatremia, syndrome of inappropriate anti-diuretic hormone secretion (SIADH) was most commonly reported, followed by adrenal insufficiency, and finally hypovolemic hyponatremia due to gastrointestinal losses. Conclusion Hyponatremia among COVID-19 patients is generally associated with poor outcomes, with SIADH being the most common underlying mechanism.
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Affiliation(s)
| | | | | | | | | | - Rabab Osman Abdulhamid
- Department of Internal Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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13
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Migliorisi A, Barger A, Austin S, Foreman JH, Wilkins P. Hyponatremia in horses with septic pneumopathy. Vet Med (Auckl) 2022; 36:1820-1826. [PMID: 36054644 PMCID: PMC9511076 DOI: 10.1111/jvim.16522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022]
Abstract
Background Hyponatremia is common in horses with bacterial pleuropneumonia, but no further characterization of this abnormality has been reported. Objectives Describe admission plasma sodium concentration ([Na]) in horses with septic pneumopathy and evaluate any association of plasma [Na] with markers of systemic inflammation. Animals Medical records of horses >1 month of age that between 2008 and 2021 had a transtracheal aspirate (TTA) performed, abnormal TTA cytology, positive TTA culture, pulmonary disease on ultrasonography, radiography or both, and plasma [Na] assessed by direct ion‐selective‐electrode (dISE). Horses with concurrent diarrhea or azotemia were excluded. Methods Clinical and clinicopathological variables of interest between hypo‐ and normonatremic horses were compared. Spearman correlation and Fisher exact tests were used to identify significant associations (P < .05). Results Twenty of 35 horses had hyponatremia (median, 132 mmol/L; 25‐75th interquartile range [IQR], 129.7‐133.1 mmol/L; reference range, 134.2‐138.4 mmol/L). A higher proportion of horses with systemic inflammatory response syndrome (SIRS) had hyponatremia (P = .01). Hyponatremic patients had higher mean plasma fibrinogen concentration (461 ± 160.5 mg/dL; P = .01) and higher rectal temperature (38.8 ± 0.7°C; P = .02) than normonatremic horses. Negative correlations were found between plasma [Na] and fibrinogen (P = .001; ρ = −0.57) concentrations and between plasma [Na] and rectal temperature (P = .001; ρ = −0.51). Presence or absence of pleural effusion did not influence severity of hyponatremia. Mean duration of hospitalization was longer (P = .04) in hyponatremic horses (9.8 ± 6.6 days). Conclusions and Clinical Importance Hyponatremia at admission is associated with the presence of inflammation, SIRS, and with longer duration of hospitalization.
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Affiliation(s)
- Alessandro Migliorisi
- College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins Colorado USA
| | - Anne Barger
- Department of Veterinary Clinical Medicine College of Veterinary Medicine, University of Illinois Urbana Illinois USA
| | - Scott Austin
- Department of Veterinary Clinical Medicine College of Veterinary Medicine, University of Illinois Urbana Illinois USA
| | - Jonathan H. Foreman
- Department of Veterinary Clinical Medicine College of Veterinary Medicine, University of Illinois Urbana Illinois USA
| | - Pamela Wilkins
- Department of Veterinary Clinical Medicine College of Veterinary Medicine, University of Illinois Urbana Illinois USA
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The impact of the correction of hyponatremia during hospital admission on the prognosis of SARS-CoV-2 infection. MEDICINA CLINICA (ENGLISH ED.) 2022; 159:12-18. [PMID: 35784827 PMCID: PMC9240945 DOI: 10.1016/j.medcle.2021.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/21/2021] [Indexed: 01/31/2023]
Abstract
Background SARS-CoV-2 infection is frequently associated with hyponatremia (plasma sodium <135 mmol/L), being associated with a worse prognosis. The incidence of hyponatremia is estimated to be 20-37% according to the series, but there are no data on the prognosis after correction of hyponatremia. Therefore, our objectives were: to analyse the incidence and severity of hyponatremia at hospital admission, and to determine the association of this hyponatremia with the prognosis of COVID-19. Methods Observational and retrospective cohort study. Patients who were admitted with a diagnosis of COVID-19 infection and hyponatremia, in the period March-May 2020, were included. We recorded epidemiological, demographic, clinical, biochemical, and radiological variables of SARS-CoV-2 infection and hyponatremia at the time of diagnosis and during hospitalization. The clinical follow-up ranged from admission to death or discharge. Results 91 patients (21.8%) of the 414 admitted for SARS-CoV-2 infection presented hyponatremia (81.32% mild hyponatremia, 9.89% moderate and 8.79% severe). The absence of correction of hyponatremia 72-96 h after hospital admission was associated with higher mortality in patients with COVID-19 (Odds Ratio 0.165; 95% confidence interval: 0.018-0.686; p = 0.011). 19 patients (20.9%) died. An increase in mortality was observed in patients with severe hyponatremia compared with moderate and mild hyponatremia during hospital admission (37.5% versus 11.1% versus 8.1%, p = 0.041). Conclusion We conclude that persistence of hyponatremia at 72-96 h of hospital admission was associated with higher mortality in patients with SARS-Cov-2.
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15
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Poch E, Molina A, Piñeiro G. Syndrome of inappropriate antidiuretic hormone secretion. Med Clin (Barc) 2022; 159:139-146. [PMID: 35659417 DOI: 10.1016/j.medcli.2022.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
Abstract
Hyponatremia is the most frequent electrolytic disorder in hospitalized patients, and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), the most frequent cause of hiponatremia with clinically normal extracellular volume. It consists of a disorder of the regulation of body water that obeys to different causes, mainly cancer, pulmonary illnesses, disorders of the central nervous system and diverse drugs. As in any hiponatremia it a physiological knowledge of the regulation of body water and sodium is essential as well as the application of precise diagnostic criteria in order to manage the problem with an effective treatment. The available data until the moment show that the clinical diagnosis of SIADH made by professionals is mainly not supported on the established criteria drawn by experts and this lack of accuracy probably hits in the therapeutic result. The basis of the treatment of the SIADH is to correct its cause, water restriction, solutes (sodium chloride) and the use of vaptans in case of failure of the previous measures.
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Affiliation(s)
- Esteban Poch
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España; IDIBAPS; Departamento de Medicina, Universidad de Barcelona, Barcelona, España.
| | - Alicia Molina
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Gastón Piñeiro
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
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16
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Sodium and potassium disorders in patients with COPD exacerbation presenting to the emergency department. BMC Emerg Med 2022; 22:49. [PMID: 35331155 PMCID: PMC8943967 DOI: 10.1186/s12873-022-00607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Electrolyte disorders are common in the emergency department. Hyponatremia is known to be associated with adverse outcome in community-acquired pneumonia (CAP) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD). No studies investigating the prevalence and influence of hypernatremia or potassium disorders in patients with AECOPD exist. Methods In this retrospective cohort analysis, the prevalence of sodium and potassium disorders was investigated in patients with AECOPD presenting to an emergency department (ED) between January 1st 2017 and December 31st 2018 and compared to all ED patients with electrolyte measurements and patients presenting with CAP. Exclusion criteria were age younger than 18 years, written or verbal withdrawal of consent and outpatient treatment. Additionally, the influence of dysnatremias and dyskalemias on outcome measured by ICU admission, need for mechanical ventilation, length of hospital stay, 30-day re-admission, 180-day AECOPD recurrence and in-hospital mortality and their role as predictors of disease severity measured by Pneumonia Severity Index (PSI) were investigated in patients with AECOPD. Results Nineteen point nine hundred forty-eight ED consultations with measurements of sodium and potassium were recognized between January 1st 2017 and December 31st 2018 of which 102 patients had AECOPD. Of these 23% had hyponatremia, 5% hypernatremia, 16% hypokalemia and 4% hyperkalemia on admission to the ED. Hypo- and hypernatremia were significantly more common in patients with AECOPD than in the overall ED population: 23 versus 11% (p = 0.001) for hypo- and 5% versus 0.6% (p < 0.001) for hypernatremia. In the logistic regression analysis, no association between the presence of either sodium or potassium disorders and adverse outcome were found. Conclusion Dysnatremias and dyskalemias are common in patients with AECOPD with as many as 1 in 5 having hyponatremia and/or hypokalemia. Hypo- and hypernatremia were significantly more common in AECOPD than overall. No significant association was found for dysnatremias, dyskalemias and adverse outcomes in AECOPD.
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17
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Machiraju PK, Alex NM, Safinaaz, Vadamalai V. Hyponatremia in Coronavirus Disease-19 Patients: A Retrospective Analysis. Can J Kidney Health Dis 2022; 8:20543581211067069. [PMID: 35003754 PMCID: PMC8728781 DOI: 10.1177/20543581211067069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Hyponatremia (serum Na+ < 135 mmol/L) is the most common
electrolyte abnormality detected in clinical practice and an important cause
of mortality and morbidity in hospital settings. Hyponatremia in patients
with pneumonia is usually mild but is associated with increased risk of
intensive care unit (ICU) admission, prolonged hospital stays, and increased
mortality rates. The purpose of this study is to understand the impact of
varying degrees of hyponatremia and various other inflammatory markers on
the severity and outcome of coronavirus disease-19 (COVID-19). Objective: The main objective of this study is to evaluate the prevalence of
hyponatremia in COVID-19 patients and to assess the correlation between
hyponatremia and severity and outcome of COVID-19. The other objective is to
evaluate the correlation between various inflammatory markers and outcome
(ICU vs non-ICU admission, discharged vs deceased) in patients with COVID-19
pneumonia. Methods: A total of 113 participants who have been diagnosed with COVID-19 infection
by reverse transcriptase-polymerase chain reaction test were included in the
study. Epidemiological, demographic, clinical, investigative work-up, and
outcome data were extracted from electronic health records using a standard
data collection form. Based on serum sodium levels, patients were divided
into two groups: normonatremic (serum Na+ ≥ 135 mEq/L) and
hyponatremic (serum Na+ < 135 mEq/L). Various clinical,
laboratory, and outcome parameters were compared between the two groups. Results: Hyponatremia was present in 50 out of 113 (44%) patients in our study, and it
was generally mild. There were more male patients in hyponatremia group
(P = .006), and hyponatremic patients were older than
normonatremic patients (P = .001). Forty (35%) of the 113
patients were transferred to the ICU, and 17 (15%) needed mechanical
ventilation during their hospitalization. Interleukin-6 (IL-6) levels were
higher in the hyponatremic group (P = .022). Intensive care
unit admissions and oxygen requirement were significantly higher in
hyponatremic patients (P = .001 and .016, respectively).
Ferritin, lactate dehydrogenase (LDH), IL-6, total leucocyte count,
erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels
were significantly elevated in those patients requiring ICU admission and
those who died due to COVID-19. Conclusions: Our study revealed that demography, clinical features, radiographic findings,
complications like renal insufficiency, and inflammatory markers like IL-6
play a considerable role in hyponatremic COVID-19 patients. Hyponatremia
patients required significantly higher rates of ICU admissions and oxygen
support. Our results suggest that monitoring inflammatory markers such as
ESR, CRP, total white blood cell (WBC) count, ferritin, LDH, and IL-6 may
serve as an early warning system for progression to severe COVID-19.
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Affiliation(s)
| | | | - Safinaaz
- Department of Internal Medicine, Apollo Hospitals, Chennai, India
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18
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Tzoulis P. Prevalence, prognostic value, pathophysiology, and management of hyponatraemia in children and adolescents with COVID-19. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021474. [PMID: 34738553 PMCID: PMC8689294 DOI: 10.23750/abm.v92i5.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022]
Abstract
Hyponatraemia is frequently encountered in adults with coronavirus disease 2019 (COVID-19) and is associated with poor prognosis. This review aims to describe for the first time the prevalence, aetiology, prognostic value, pathophysiology, and management of hyponatraemia in children and adolescents with COVID-19, taking into account all relevant studies published in PubMed and Cochrane Library studies until 26th September 2021. Literature search did not detect any studies evaluating the prevalence and prognostic value of sodium disorders in paediatric patients with COVID-19. A broader literature review showed a high prevalence of hyponatraemia in children with bacterial pneumonia, while some studies have reported that hyponatraemia is relatively common in Multisystem Inflammatory Syndrome in Children (MIS-C). In adults with COVID-19, an inverse association between sodium and interleukin-6 levels has been found, indicating that hyponatraemia could be used as a surrogate marker for the risk of cytokine storm and may facilitate the identification of patients who could benefit from immunomodulatory agents. Studies are urgently needed to evaluate the frequency and prognostic impact of electrolyte abnormalities in children with COVID-19. In the meantime, clinicians are urged to consider hyponatraemia in children with COVID-19 as a potential red flag, investigate the cause and administer fluids and other therapies accordingly.
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19
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Martino M, Falcioni P, Giancola G, Ciarloni A, Salvio G, Silvetti F, Taccaliti A, Arnaldi G. Sodium alterations impair the prognosis of hospitalized patients with COVID-19 pneumonia. Endocr Connect 2021; 10:1344-1351. [PMID: 34533476 PMCID: PMC8558885 DOI: 10.1530/ec-21-0411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Dysnatremia is common in hospitalized patients, often worsening the prognosis in pneumopathies and critical illnesses. Information on coronavirus disease-19 (COVID-19)-related hyponatremia is partially conflicting, whereas data on hypernatremia in this context are scarce. We assessed, in a cohort of COVID-19 inpatients: the prevalence of sodium alterations at admission and throughout their hospitalization; their association with inflammation/organ damage indexes; their short-term prognostic impact. STUDY DESIGN AND METHODS 117 patients (81 males, 64 ± 13 years) hospitalized for COVID-19 between 1 March and 30 April 2020 were retrospectively followed-up for their first 21 days of stay by collecting all serum sodium measurements, basal CRP and serum lactate levels, maximum IL-6 and information on care setting, required ventilation, length of hospitalization, in-hospital death. RESULTS At admission, 26.5% patients had hyponatremia, and 6.8% had hypernatremia. During their hospitalization, 13.7% patients experienced both disorders ('mixed dysnatremia'). Lower sodium levels at admission were correlated with higher C reactive protein (CRP) (P = 0.039) and serum lactate levels (P = 0.019), but not interleukin-6 (IL-6). Hypernatremia and a wider sodium variability were associated with maximum required ventilation, need for ICU assistance and duration of the hospitalization. Mean estimated time to Intensive Care Unit (ICU) admission was 20 days shorter in patients exposed to sodium alterations at any time of their hospital course (log-rank test P = 0.032). CONCLUSIONS Sodium alterations frequently affect hospitalized COVID-19 patients. Hyponatremia could indicate pulmonary involvement, whereas hypernatremia is associated to prolonged hospitalization and the need for intensive care/mechanical ventilation, particularly when resulting from prior hyponatremia. Optimizing in-hospital sodium balance is crucial to improve patients' prognosis.
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Affiliation(s)
- Marianna Martino
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences (DISCLIMO), Polytechnic University of Marche, Ancona, Italy
| | - Paolo Falcioni
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences (DISCLIMO), Polytechnic University of Marche, Ancona, Italy
| | - Giulia Giancola
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences (DISCLIMO), Polytechnic University of Marche, Ancona, Italy
| | - Alessandro Ciarloni
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences (DISCLIMO), Polytechnic University of Marche, Ancona, Italy
| | - Gianmaria Salvio
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences (DISCLIMO), Polytechnic University of Marche, Ancona, Italy
| | - Francesca Silvetti
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences (DISCLIMO), Polytechnic University of Marche, Ancona, Italy
| | - Augusto Taccaliti
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences (DISCLIMO), Polytechnic University of Marche, Ancona, Italy
| | - Giorgio Arnaldi
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences (DISCLIMO), Polytechnic University of Marche, Ancona, Italy
- Correspondence should be addressed to G Arnaldi:
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de La Flor JC, Gomez-Berrocal A, Marschall A, Valga F, Linares T, Albarracin C, Ruiz E, Gallegos G, Gómez A, de Los Santos A, Rodeles M. The impact of the correction of hyponatremia during hospital admission on the prognosis of SARS-CoV-2 infection. Med Clin (Barc) 2021; 159:12-18. [PMID: 34635318 PMCID: PMC8318697 DOI: 10.1016/j.medcli.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION SARS-CoV-2 infection is frequently associated with hyponatremia (plasma sodium<135mmol/L), being associated with a worse prognosis. The incidence of hyponatremia is estimated to be 20-37% according to the series, but there are no data on the prognosis after correction of hyponatremia. Therefore, our objectives were: to analyze the incidence and severity of hyponatremia at hospital admission, and to determine the association of this hyponatremia with the prognosis of COVID-19. MATERIAL AND METHOD Observational and retrospective cohort study. Patients who were admitted with a diagnosis of COVID-19 infection and hyponatremia, in the period March-May 2020, were included. We recorded epidemiological, demographic, clinical, biochemical, and radiological variables of SARS-CoV-2 infection and hyponatremia at the time of diagnosis and during hospitalization. The clinical follow-up ranged from admission to death or discharge. RESULTS 91 patients (21.8%) of the 414 admitted for SARS-CoV-2 infection presented hyponatremia (81.32% mild hyponatremia, 9.89% moderate and 8.79% severe). The absence of correction of hyponatremia 72-96h after hospital admission was associated with higher mortality in patients with COVID-19 (Odds Ratio .165; 95% confidence interval: .018-.686; P=.011). 19 patients (20.9%) died. An increase in mortality was observed in patients with severe hyponatremia compared with moderate and mild hyponatremia during hospital admission (37.5% versus 11.1% versus 8.1%, P=.041). CONCLUSIONS We conclude that persistence of hyponatremia at 72-96h of hospital admission was associated with higher mortality in patients with SARS-CoV-2.
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Affiliation(s)
- José C de La Flor
- Servicio de Nefrología, Hospital Central de la Defensa Gómez Ulla, Madrid, España.
| | - Ana Gomez-Berrocal
- Servicio de Medicina Interna, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - Alexander Marschall
- Servicio de Cardiología, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - Francisco Valga
- Servicio de Nefrología, Hospital Negrín, Gran Canaria, España
| | - Tania Linares
- Servicio de Nefrología, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - Cristina Albarracin
- Servicio de Nefrología, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - Elisa Ruiz
- Servicio de Nefrología, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - Gioconda Gallegos
- Servicio de Nefrología, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - Alberto Gómez
- Facultad de Medicina, Universidad Alcalá de Henares, Madrid, España
| | | | - Miguel Rodeles
- Servicio de Nefrología, Hospital Central de la Defensa Gómez Ulla, Madrid, España
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21
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Martino M, Salvio G, Cutini M, Arnaldi G, Balercia G. COVID-19 and endocrine and metabolic disorders: critical points and suggestions for a correct therapeutic management from a tertiary endocrine center in Italy. Minerva Endocrinol (Torino) 2021; 47:117-126. [PMID: 34309348 DOI: 10.23736/s2724-6507.21.03523-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Coronavirus-19 (COVID-19) pandemic, which began in December 2019 in Wuhan, China, has spread rapidly worldwide, affecting mostly frail individuals and resulting in high lethality among people with chronic conditions. The management of chronic endocrine disorders during the pandemic period proved particularly challenging, as they require close physician-patient contact for proper long-term management. In addition, acute endocrinologic conditions that presented during the COVID-19 period required timely management in an unusual clinical setting, providing an ongoing challenge for clinicians. This article summarizes the most recent guidance on the management and therapy of frequent conditions such as diabetes and osteoporosis and less common endocrine disorders (e.g., adrenal insufficiency) in this setting.
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Affiliation(s)
- Marianna Martino
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Gianmaria Salvio
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Melissa Cutini
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Giorgio Arnaldi
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Giancarlo Balercia
- Division of Endocrinology and Metabolic Diseases, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy -
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22
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Akbar MR, Pranata R, Wibowo A, Irvan, Sihite TA, Martha JW. The Prognostic Value of Hyponatremia for Predicting Poor Outcome in Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:666949. [PMID: 34195209 PMCID: PMC8236602 DOI: 10.3389/fmed.2021.666949] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/10/2021] [Indexed: 12/27/2022] Open
Abstract
Background: This meta-analysis aimed to assess the prognostic value of hyponatremia in patients with COVID-19. Methods: We performed a systematic literature search on PubMed, Scopus, ScienceDirect, and Wiley up until January 26, 2021. The key exposure was hyponatremia, defined as sodium level below the reference level. The outcome of interest was poor outcome, which was a composite of mortality, severe COVID-19, and prolonged hospitalization. Severe COVID-19 was defined severe CAP or needing ICU care or IMV. The pooled effect estimate was odds ratio (OR). Sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic OR (DOR), and area under curve (AUC) were generated. Results: There were 11,493 patients from eight studies included in this systematic review and meta-analysis. The incidence of hyponatremia was 24%, and incidence of poor outcome was 20%. Hyponatremia was associated with poor outcome in COVID-19 (OR 2.65 [1.89, 3.72], p < 0.001; I2: 67.2%). Meta-regression analysis showed that the association between hyponatremia and poor outcome was reduced by age (OR 0.94 [0.90, 0.98], p = 0.006) and hypertension (OR 0.96 [0.93, 0.94], p < 0.001). Hyponatremia has a sensitivity of 0.37 [0.27, 0.48], specificity of 0.82 [0.72, 0.88], PLR of 2.0 [1.5, 2.7], NLR of 0.77 [0.69, 0.87], DOR of 3 [2, 4], and AUC of 0.62 [0.58, 0.66] for predicting poor outcome. In this pooled analysis, hyponatremia has a 33% posttest probability for poor outcome, and absence of hyponatremia confers to a 16% posttest probability. Conclusion: Hyponatremia was associated with poor outcome in patients with COVID-19. Systematic Review Registration: PROSPERO, CRD42021233592.
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Affiliation(s)
- Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.,Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | - Irvan
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Teddy Arnold Sihite
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | - Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
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23
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Berni A, Malandrino D, Corona G, Maggi M, Parenti G, Fibbi B, Poggesi L, Bartoloni A, Lavorini F, Fanelli A, Scocchera G, Nozzoli C, Peris A, Pieralli F, Pini R, Ungar A, Peri A. Serum sodium alterations in SARS CoV-2 (COVID-19) infection: impact on patient outcome. Eur J Endocrinol 2021; 185:137-144. [PMID: 33950864 PMCID: PMC9494309 DOI: 10.1530/eje-20-1447] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/05/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Hyponatremia is the most common electrolyte disorder in hospitalized patients and occurs in about 30% of patients with pneumonia. Hyponatremia has been associated with a worse outcome in several pathologic conditions The main objective of this study was to determine whether serum sodium alterations may be independent predictors of the outcome of hospitalized COVID-19 patients. DESIGN AND METHODS In this observational study, data from 441 laboratory-confirmed COVID-19 patients admitted to a University Hospital were collected. After excluding 61 patients (no serum sodium at admission available, saline solution infusion before sodium assessment, transfer from another hospital), data from 380 patients were analyzed. RESULTS 274 (72.1%) patients had normonatremia at admission, 87 (22.9%) patients had hyponatremia and 19 (5%) patients had hypernatremia. We found an inverse correlation between serum sodium and IL-6, whereas a direct correlation between serum sodium and PaO2/FiO2 ratio was observed. Patients with hyponatremia had a higher prevalence of non-invasive ventilation and ICU transfer than those with normonatremia or hypernatremia. Hyponatremia was an independent predictor of in-hospital mortality (2.7-fold increase vs normonatremia) and each mEq/L of serum sodium reduction was associated with a 14.4% increased risk of death. CONCLUSIONS These results suggest that serum sodium at admission may be considered as an early prognostic marker of disease severity in hospitalized COVID-19 patients.
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Affiliation(s)
- Andrea Berni
- Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy
| | - Danilo Malandrino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | - Mario Maggi
- Endocrinology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
| | - Gabriele Parenti
- Endocrinology Unit, Careggi University Hospital, Florence, Italy
- Pituitary Diseases and Sodium Alterations Unit, Careggi University Hospital, Florence, Italy
| | - Benedetta Fibbi
- Endocrinology Unit, Careggi University Hospital, Florence, Italy
- Pituitary Diseases and Sodium Alterations Unit, Careggi University Hospital, Florence, Italy
| | - Loredana Poggesi
- Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Pneumology and Thoraco Pulmonary Pathophysiology Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Fanelli
- Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy
| | - Giulia Scocchera
- Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit 1, Careggi University Hospital, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Center, Careggi University Hospital, Florence, Italy
| | - Filippo Pieralli
- High Intensity Internal Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Riccardo Pini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Internal and Emergency Medicine, Careggi Hospital, Florence, Italy
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Geriatric-UTIG Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Peri
- Endocrinology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
- Pituitary Diseases and Sodium Alterations Unit, Careggi University Hospital, Florence, Italy
- Correspondence should be addressed to A Peri Email
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24
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Tzoulis P, Waung JA, Bagkeris E, Hussein Z, Biddanda A, Cousins J, Dewsnip A, Falayi K, McCaughran W, Mullins C, Naeem A, Nwokolo M, Quah H, Bitat S, Deyab E, Ponnampalam S, Bouloux PM, Montgomery H, Baldeweg SE. Dysnatremia is a Predictor for Morbidity and Mortality in Hospitalized Patients with COVID-19. J Clin Endocrinol Metab 2021; 106:1637-1648. [PMID: 33624101 PMCID: PMC7928894 DOI: 10.1210/clinem/dgab107] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Dysnatremia is an independent predictor of mortality in patients with bacterial pneumonia. There is paucity of data about the incidence and prognostic impact of abnormal sodium concentration in patients with coronavirus disease 2019 (COVID-19). OBJECTIVE This work aimed to examine the association of serum sodium during hospitalization with key clinical outcomes, including mortality, need for advanced respiratory support and acute kidney injury (AKI), and to explore the role of serum sodium as a marker of inflammatory response in COVID-19. METHODS This retrospective longitudinal cohort study, including all adult patients who presented with COVID-19 to 2 hospitals in London over an 8-week period, evaluated the association of dysnatremia (serum sodium < 135 or > 145 mmol/L, hyponatremia, and hypernatremia, respectively) at several time points with inpatient mortality, need for advanced ventilatory support, and AKI. RESULTS The study included 488 patients (median age, 68 years). At presentation, 24.6% of patients were hyponatremic, mainly due to hypovolemia, and 5.3% hypernatremic. Hypernatremia 2 days after admission and exposure to hypernatremia at any time point during hospitalization were associated with a 2.34-fold (95% CI, 1.08-5.05; P = .0014) and 3.05-fold (95% CI, 1.69-5.49; P < .0001) increased risk of death, respectively, compared to normonatremia. Hyponatremia at admission was linked with a 2.18-fold increase in the likelihood of needing ventilatory support (95% CI, 1.34-3.45, P = .0011). Hyponatremia was not a risk factor for in-hospital mortality, except for the subgroup of patients with hypovolemic hyponatremia. Sodium values were not associated with the risk for AKI and length of hospital stay. CONCLUSION Abnormal sodium levels during hospitalization are risk factors for poor prognosis, with hypernatremia and hyponatremia being associated with a greater risk of death and respiratory failure, respectively. Serum sodium values could be used for risk stratification in patients with COVID-19.
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Affiliation(s)
- Ploutarchos Tzoulis
- Department of Metabolism & Experimental Therapeutics, Division of Medicine, University College London, London, UK
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
- Correspondence: Ploutarchos Tzoulis, MD, PhD, MSc (Hons), MRCP, Department of Metabolism & Experimental Therapeutics, Division of Medicine, University College London, Gower St, WC1E 6BT, London, UK.
| | - Julian A Waung
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Emmanouil Bagkeris
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Ziad Hussein
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| | - Aiyappa Biddanda
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - John Cousins
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Alice Dewsnip
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Kanoyin Falayi
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Will McCaughran
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Chloe Mullins
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Ammara Naeem
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Muna Nwokolo
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Helen Quah
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Syed Bitat
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Eithar Deyab
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Swarupini Ponnampalam
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Pierre-Marc Bouloux
- Centre for Neuroendocrinology, Royal Free Campus, University College London, London, UK
| | - Hugh Montgomery
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
- UCL Institute for Human Health and Performance, University College London, London, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
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25
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Hyponatremia is a Prognostic Factor in Patients Receiving Nutrition Support. Am J Med Sci 2021; 361:744-750. [PMID: 33941365 DOI: 10.1016/j.amjms.2020.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/07/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hyponatremia, the most common electrolyte disorder, has been reported to be related to increased mortality. However, the association between hyponatremia and prognoses remains unclear in patients with nutrition support team (NST) intervention. This study aimed to determine the prevalence of abnormal serum sodium levels, its relation to patient data, and the impact of hyponatremia on prognosis. METHODS Patients who received nutrition support at Tokushima University Hospital for the first time and whose serum sodium levels were measured at the start of NST intervention were enrolled. Patients were classified into three groups according to their serum Na levels at the start of NST intervention: hyponatremia group, normonatremia group, and hypernatremia group. RESULTS In the hyponatremia group compared to the normonatremia group, body weight and body mass index were significantly lower. C-reactive protein levels and urea nitrogen/creatinine ratios were significantly higher. Meanwhile, there was no significant difference in the estimated glomerular filtration rate among the groups. The prevalence of malnutrition and anemia were the highest in the hyponatremia group. The 3-year survival rate was approximately 45% in the hyponatremia group, which was the lowest of all three groups. The mortality risk ratio of the hyponatremia group to the normonatremia group was 2.29. CONCLUSIONS Hyponatremia in NST intervention patients is an independent prognostic predictor. Therefore, adding an assessment of serum sodium at the beginning of NST intervention can identify patients at high risk at an early stage and may improve the quality of NST activity.
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26
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Atila C, Sailer CO, Bassetti S, Tschudin-Sutter S, Bingisser R, Siegemund M, Osswald S, Rentsch K, Rueegg M, Schaerli S, Kuster GM, Twerenbold R, Christ-Crain M. Prevalence and outcome of dysnatremia in patients with COVID-19 compared to controls. Eur J Endocrinol 2021; 184:409-418. [PMID: 33449918 PMCID: PMC9494345 DOI: 10.1530/eje-20-1374] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/12/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The pandemic of coronavirus disease (COVID-19) has rapidly spread globally and infected millions of people. The prevalence and prognostic impact of dysnatremia in COVID-19 is inconclusive. Therefore, we investigated the prevalence and outcome of dysnatremia in COVID-19. DESIGN The prospective, observational, cohort study included consecutive patients with clinical suspicion of COVID-19 triaged to a Swiss Emergency Department between March and July 2020. METHODS Collected data included clinical, laboratory and disease severity scoring parameters on admission. COVID-19 cases were identified based on a positive nasopharyngeal swab test for SARS-CoV-2, patients with a negative swab test served as controls. The primary analysis was to assess the prognostic impact of dysnatremia on 30-day mortality using a cox proportional hazard model. RESULTS 172 (17%) cases with COVID-19 and 849 (83%) controls were included. Patients with COVID-19 showed a higher prevalence of hyponatremia compared to controls (28.1% vs 17.5%, P < 0.001); while comparable for hypernatremia (2.9% vs 2.1%, P = 0.34). In COVID-19 but not in controls, hyponatremia was associated with a higher 30-day mortality (HR: 1.4, 95% CI: 1.10-16.62, P = 0.05). In both groups, hypernatremia on admission was associated with higher 30-day mortality (COVID-19 - HR: 11.5, 95% CI: 5.00-26.43, P < 0.001; controls - HR: 5.3, 95% CI: 1.60-17.64, P = 0.006). In both groups, hyponatremia and hypernatremia were significantly associated with adverse outcome, for example, intensive care unit admission, longer hospitalization and mechanical ventilation. CONCLUSION Our results underline the importance of dysnatremia as predictive marker in COVID-19. Treating physicians should be aware of appropriate treatment measures to be taken for patients with COVID-19 and dysnatremia.
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Affiliation(s)
- Cihan Atila
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Department of Clinical Research, Basel, Switzerland
| | - Clara O Sailer
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Department of Clinical Research, Basel, Switzerland
| | - Stefano Bassetti
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- University of Basel, Department of Clinical Research, Basel, Switzerland
- Division of Infectious Disease & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Marco Rueegg
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Sabrina Schaerli
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Gabriela M Kuster
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Correspondence should be addressed to R Twerenbold;
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Department of Clinical Research, Basel, Switzerland
- Correspondence should be addressed to M Christ-Crain;
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27
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Ravioli S, Gygli R, Funk GC, Exadaktylos A, Lindner G. Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis. Eur J Intern Med 2021; 85:63-67. [PMID: 33358686 DOI: 10.1016/j.ejim.2020.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/05/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Disorders of sodium and potassium are common and predictors of adverse outcome. Prevalence and impact on outcome of hypokalemia, hyperkalemia, hyponatremia and hypernatremia were investigated in emergency patients with community-acquired pneumonia (CAP). METHODS Patients ≥18 years presenting to our emergency department between January 1st 2017 and December 31st 2018 with on-admission electrolyte measurements were included. Chart reviews were performed to identify patients with CAP. RESULTS 19.948 cases had measurements of sodium and potassium of which 469 had CAP (2.4%). Prevalence of hypo- and hypernatremia was significantly increased in patients with compared to those without CAP (hyponatremia: 28.8% vs. 10.5% respectively, p<0.0001; hypernatremia: 1.9% vs. 0.6% respectively, p=0.002). The prevalence of hypo- and hyperkalemia was significantly higher in patients with than without CAP (hypokalemia 15.6% vs. 11.4% respectively, p=0.004; hyperkalemia: 4.5% vs. 2.0% respectively, p=0.001). Hyponatremia was significantly associated with longer hospital stay in patients with CAP (regression coefficient 0.194, standard error 0.079, p=0.015). None of the investigated electrolyte disorders were predictive of 30-day re-admission and 180-day pneumonia recurrence rates. Use of loop diuretics was an independent predictor for 30-day re-admission (OR 2.351 (1.099-5.03). p=0.028). Pneumonia Severity Index (PSI) risk class was an independent predictor of 180-day pneumonia recurrence (OR 1.494 (1.022-2.184), p=0.038). CONCLUSION Dysnatremias and dyskalemias are common findings complicating CAP in emergency patients. Prevalence of hyponatremia was highest followed by hypokalemia. Hyponatremia was an independent predictor of prolonged length of hospital stay. Loop diuretic use was associated with 30-day readmission and PSI risk class with 180-day pneumonia recurrence.
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland.
| | - Rebecca Gygli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | | | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
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Frontera JA, Valdes E, Huang J, Lewis A, Lord AS, Zhou T, Kahn DE, Melmed K, Czeisler BM, Yaghi S, Scher E, Wisniewski T, Balcer L, Hammer E. Prevalence and Impact of Hyponatremia in Patients With Coronavirus Disease 2019 in New York City. Crit Care Med 2020; 48:e1211-e1217. [PMID: 32826430 PMCID: PMC7467047 DOI: 10.1097/ccm.0000000000004605] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Hyponatremia occurs in up to 30% of patients with pneumonia and is associated with increased morbidity and mortality. The prevalence of hyponatremia associated with coronavirus disease 2019 and the impact on outcome is unknown. We aimed to identify the prevalence, predictors, and impact on outcome of mild, moderate, and severe admission hyponatremia compared with normonatremia among coronavirus disease 2019 patients. DESIGN Retrospective, multicenter, observational cohort study. SETTING Four New York City hospitals that are part of the same health network. PATIENTS Hospitalized, laboratory-confirmed adult coronavirus disease 2019 patients admitted between March 1, 2020, and May 13, 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Hyponatremia was categorized as mild (sodium: 130-134 mmol/L), moderate (sodium: 121-129 mmol/L), or severe (sodium: ≤ 120 mmol/L) versus normonatremia (135-145 mmol/L). The primary outcome was the association of increasing severity of hyponatremia and in-hospital mortality assessed using multivariable logistic regression analysis. Secondary outcomes included encephalopathy, acute renal failure, mechanical ventilation, and discharge home compared across sodium levels using Kruskal-Wallis and chi-square tests. In exploratory analysis, the association of sodium levels and interleukin-6 levels (which has been linked to nonosmotic release of vasopressin) was assessed. Among 4,645 patient encounters, hyponatremia (sodium < 135 mmol/L) occurred in 1,373 (30%) and 374 of 1,373 (27%) required invasive mechanical ventilation. Mild, moderate, and severe hyponatremia occurred in 1,032 (22%), 305 (7%), and 36 (1%) patients, respectively. Each level of worsening hyponatremia conferred 43% increased odds of in-hospital death after adjusting for age, gender, race, body mass index, past medical history, admission laboratory abnormalities, admission Sequential Organ Failure Assessment score, renal failure, encephalopathy, and mechanical ventilation (adjusted odds ratio, 1.43; 95% CI, 1.08-1.88; p = 0.012). Increasing severity of hyponatremia was associated with encephalopathy, mechanical ventilation, and decreased probability of discharge home (all p < 0.001). Higher interleukin-6 levels correlated with lower sodium levels (p = 0.017). CONCLUSIONS Hyponatremia occurred in nearly a third of coronavirus disease 2019 patients, was an independent predictor of in-hospital mortality, and was associated with increased risk of encephalopathy and mechanical ventilation.
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Affiliation(s)
| | - Eduard Valdes
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Joshua Huang
- Department of Medical Center Information Technology, NYU Grossman School of Medicine, New York, NY
| | - Ariane Lewis
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Aaron S. Lord
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Ting Zhou
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - D. Ethan Kahn
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Kara Melmed
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Barry M. Czeisler
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Shadi Yaghi
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Erica Scher
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Thomas Wisniewski
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
- Department of Pathology, NYU Grossman School of Medicine, New York, NY
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Laura Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Elizabeth Hammer
- Department of Medicine, NYU Grossman School of Medicine, New York, NY
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Rech JS, Yao K, Bachmeyer C, Bailleul S, Javier O, Grateau G, Lionnet F, Steichen O. Prognostic Value of Hyponatremia During Acute Painful Episodes in Sickle Cell Disease. Am J Med 2020; 133:e465-e482. [PMID: 32199810 DOI: 10.1016/j.amjmed.2020.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/22/2019] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Low plasma sodium concentration has been recognized as a prognostic factor in several disorders but never evaluated in sickle cell disease. The present study evaluates its value at admission to predict a complication in adult patients with sickle cell disease hospitalized for an initially uncomplicated acute painful episode. METHODS The primary outcome of this retrospective study, performed between 2010 and 2015 in a French referral center for sickle cell disease, was a composite criterion including acute chest syndrome, intensive care unit transfer, red blood cell transfusion or inpatient death. Analyses were adjusted for age, sex, hemoglobin genotype and concentration, lactate dehydrogenase (LDH) concentration, and white blood cell count. RESULTS We included 1218 stays (406 patients). No inpatient death occurred during the study period. Hyponatremia (plasma sodium ≤135 mmol/L) at admission in the center was associated with the primary outcome (adjusted odds ratio [OR] 1.95, 95% confidence interval [CI] 1.3-2.91, P = 0.001), with acute chest syndrome (OR 1.95 [95% CI 1.2-3.17, P = 0.008]), and red blood cell transfusion (OR 2.71 [95% CI 1.58-4.65, P <0.001]) but not significantly with intensive care unit transfer (OR 1.83 [95% CI 0.94-3.79, P = 0.074]). Adjusted mean length of stay was longer by 1.1 days (95% CI 0.5-1.6, P <0.001) in patients with hyponatremia at admission. CONCLUSIONS Hyponatremia at admission in the medical department for an acute painful episode is a strong and independent prognostic factor of unfavorable outcome and, notably, acute chest syndrome. It could help targeting patients who may benefit from closer monitoring.
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Affiliation(s)
- Jean-Simon Rech
- Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique Drépanocytose Recherche à Paris Sorbonne Université, Sorbonne University, Paris, France
| | - Kan Yao
- Department of Information Systems, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claude Bachmeyer
- Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Bailleul
- Department of Biochemistry, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Orlando Javier
- Department of Medical Information, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilles Grateau
- Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Medical Information, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Lionnet
- Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique Drépanocytose Recherche à Paris Sorbonne Université, Sorbonne University, Paris, France
| | - Olivier Steichen
- Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique Drépanocytose Recherche à Paris Sorbonne Université, Sorbonne University, Paris, France.
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30
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Potasso L, Sailer CO, Blum CA, Cesana-Nigro N, Schuetz P, Mueller B, Christ-Crain M. Mild to moderate hyponatremia at discharge is associated with increased risk of recurrence in patients with community-acquired pneumonia. Eur J Intern Med 2020; 75:44-49. [PMID: 31952985 DOI: 10.1016/j.ejim.2019.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Hyponatremia is the most common electrolyte disorder in hospitalized patients with pneumonia. Different studies have shown an association of hyponatremia on admission and worse patient's outcome. Yet, the impact of hyponatremia at discharge or of hyponatremia correction on patient's prognosis is unknown. METHODS This is a preplanned secondary data analysis from a double-blind, randomized, placebo-controlled trial of hospitalized patients with community-acquired pneumonia and prednisone treatment. The primary outcome was the impact of hyponatremia on admission and at discharge on patient relevant outcomes (i.e. mortality, rehospitalization and recurrence rate) within 180 days. RESULTS Of the 708 included patients, 185 (26.1%) were hyponatremic on admission. Of these, 28 (15.1%) were still hyponatremic at discharge. 34 (4.8%) patients developed hyponatremia during hospitalization despite being normonatremic on admission. Patients with hyponatremia at discharge had a higher rate of pneumonia recurrence as compared to normonatremic patients (OR 2.68; 95%-CI 1.09-6.95; p = 0.037). Among patients with hyponatremia at discharge, patients who were already hyponatremic on admission showed the strongest association with increased recurrence rate (OR 4.01; 95%-CI 1.08-12.64; p = 0.022). In contrast, recurrence rate was not affected in patients who were hyponatremic on admission but had normalized serum sodium levels at discharge (p = 0.73). CONCLUSION Mild to moderate hyponatremia at discharge is associated with an increased risk of recurrence in hospitalized patients with pneumonia. This association is particularly strong for patients who are hyponatremic both on admission and at discharge, emphasizing the importance of hyponatremia correction during hospitalization.
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Affiliation(s)
- Laura Potasso
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Clara Odilia Sailer
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Claudine Angela Blum
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Division of General Internal and Emergency Medicine, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland; Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Nicole Cesana-Nigro
- Department of Endocrinology and Diabetology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland; Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of General Internal and Emergency Medicine, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland; Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
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Sharma K, Sood N, Himral P, Sharma T, Kapoor D. Clinical profile of patients with hyponatremia in a tertiary care hospital in the sub-Himalayan region. J Family Med Prim Care 2020; 9:834-838. [PMID: 32318430 PMCID: PMC7113994 DOI: 10.4103/jfmpc.jfmpc_788_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/28/2019] [Accepted: 01/06/2020] [Indexed: 11/12/2022] Open
Abstract
Introduction: Hyponatremia, defined as a serum sodium concentration ([Na+]) <135 mEq/L. It is not a disease but rather a pathophysiologic process indicating disturbed water homeostasis. Hyponatremia should be further classified to provide directions for diagnosis and treatment. It is a heterogeneous disorder. The classifications of hyponatremia are commonly based on tonicity and volume status. The initial differentiation in hypotonic and non-hypotonic hyponatremia is important because management is different. Several studies have been conducted previously to measure the incidence of hyponatremia in medically ill patients. Several studies have demonstrated an increased prevalence of hyponatremia in the presence of co-morbid conditions. We conducted this study to bring out various causes of hyponatremia; their relation with sex, age and outcome and hyponatremia's classification and incidence in our hospitalised population. Materials and Methods: This study was conducted to find out etiology, classification, prevalence and outcome and its relation with age and sex in patients of hyponatremia admitted in our institution. A total number of 106 patients were studied. Results: Hospital-based incidence of hyponatremia was found to be 1.17%. Mean age of patients in study was 62.25 ± 17.7 years. Male to female ratio was 1.25:1. Altered sensorium was the most common neurological symptom. Ninety-five (90%) patients were hypo-osmolar. Out of ninety four patients, 38 (40%) were euvolemic. Chronic obstructive pulmonary disorder (COPD) with cor pulmonale with right-sided heart failure (n = 9, 31%) was the most common cause in hyper-volemic hyponatremia. Acute gastroenteritis (n = 13, 48%) was the most common cause in hypo-volemic hyponatremia. Syndrome of inappropriate anti-diuretic hormone secretion (SIADH) was the most common cause (n = 20, 53%) of euvolemic hyponatremia. Out of 106 patients, 11 (10.38%) patients expired. Conclusion: Hyponatremia acts as a poor prognostic marker of the primary disease. It is important to recognise it early because of the potential morbidity and mortality, economic impact on the patients and health care associated with it. Early management of hyponatremia, which includes determination of the rate of correction, the appropriate interventions and the presence of other underlying disorders, may help in improving the outcome and shortening the hospital stay of the patients.
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Ruiz-Sánchez JG, Núñez-Gil IJ, Cuesta M, Rubio MA, Maroun-Eid C, Arroyo-Espliguero R, Romero R, Becerra-Muñoz VM, Uribarri A, Feltes G, Trabattoni D, Molina M, García Aguado M, Pepe M, Cerrato E, Alfonso E, Castro Mejía AF, Roubin SR, Buzón L, Bondia E, Marin F, López Pais J, Abumayyaleh M, D’Ascenzo F, Rondano E, Huang J, Fernandez-Perez C, Macaya C, de Miguel Novoa P, Calle-Pascual AL, Estrada Perez V, Runkle I. Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis. Front Endocrinol (Lausanne) 2020; 11:599255. [PMID: 33329400 PMCID: PMC7734292 DOI: 10.3389/fendo.2020.599255] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/05/2020] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED 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 REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04334291, NCT04334291.
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Affiliation(s)
- Jorge Gabriel Ruiz-Sánchez
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- *Correspondence: Jorge Gabriel Ruiz-Sánchez,
| | - Ivan J. Núñez-Gil
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Martin Cuesta
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Miguel A. Rubio
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Charbel Maroun-Eid
- Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | - Rodolfo Romero
- Hospital Universitario Getafe, Universidad Europea de Madrid, Madrid, Spain
| | | | - Aitor Uribarri
- Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | | | - María Molina
- Hospital Universitario Severo Ochoa, Madrid, Spain
| | | | - Martino Pepe
- Azienda ospedaliero-universitaria consorziale policlinico di Bari, Bari, Italy
| | - Enrico Cerrato
- San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Emilio Alfonso
- Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
| | | | | | - Luis Buzón
- Hospital Universitario de Burgos, Burgos, Spain
| | - Elvira Bondia
- Hospital Clínico Universitario, Incliva, Universidad de Valencia, Valencia, Spain
| | | | | | - Mohammad Abumayyaleh
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany, DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | | | | | - Jia Huang
- The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Cristina Fernandez-Perez
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Macaya
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Paz de Miguel Novoa
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Alfonso L. Calle-Pascual
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Vicente Estrada Perez
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Isabelle Runkle
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - HOPE COVID-19 investigators
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Cuesta M, Slattery D, Goulden EL, Gupta S, Tatro E, Sherlock M, Tormey W, O'Neill S, Thompson CJ. Hyponatraemia in patients with community-acquired pneumonia; prevalence and aetiology, and natural history of SIAD. Clin Endocrinol (Oxf) 2019; 90:744-752. [PMID: 30657193 DOI: 10.1111/cen.13937] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/07/2018] [Accepted: 01/11/2019] [Indexed: 11/30/2022]
Abstract
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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Affiliation(s)
- Martin Cuesta
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - David Slattery
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - Eirena L Goulden
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - Saket Gupta
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - Elizabeth Tatro
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - Mark Sherlock
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - William Tormey
- Academic Department of Chemical Pathology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - Shane O'Neill
- Academic Department of Respiratory Medicine, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - Christopher J Thompson
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
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Grangeon-Chapon C, Dodoi M, Esnault VL, Favre G. Osmotic stress and mortality in elderly patients with kidney failure: a retrospective study. Clin Interv Aging 2019; 14:225-229. [PMID: 30787598 PMCID: PMC6363396 DOI: 10.2147/cia.s158987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Water balance disorders are associated with a high risk of death in elderly patients. The role of osmotic stress intensity and its direction toward hypo- or hypernatremia is a matter of controversy regarding patients’ survival. The aims of this study were, first, to measure the frequency of cellular hydration disorders in patients over 75 years old hospitalized in nephrology department for reversible acute renal failure, and second, to compare the impact of hyperhydration and hypohydration on the risk of death at 6 months. Patients and methods We retrospectively studied the data of 279 patients with chronic kidney disease (CKD), aged 75 years or older, with pre-renal azotemia who experienced dysnatremia. We classified them according to natremia levels and compared their outcome in univariate and multivariate analysis. Results The patients were on average 83.2±5.4 years old. Among them, 128 were normonatremic, 82 were hyponatremic and 69 were hypernatremic. Osmotic stress intensity appreciated by the variation rate of natremia did not differ significantly between hyper- and hyponatremic patients. Patients had CKD stage 3B and 4 with acute kidney injury (AKI) of different severities. We observed that only hypernatremia was linked to death in the first 6 months following hospital discharge. Conclusion Hypernatremia is a strong predictor of fatal outcome in elderly patients suffering from chronic kidney impairment and referred for pre-renal azotemia.
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Affiliation(s)
- Caroline Grangeon-Chapon
- Departments of Nuclear Medicine and Pharmacy, University Côte d'Azur, University Hospital of Nice, Nice, France,
| | - Manuella Dodoi
- Department of Nephrology, University Côte d'Azur, University Hospital of Nice, Nice, France
| | - Vincent Lm Esnault
- Department of Nephrology, University Côte d'Azur, University Hospital of Nice, Nice, France.,Department of Nephrology, University Côte d'Azur, Institute for Research on Cancer and Aging of Nice (IRCAN), "Aging and Diabetes" Team, University Hospital of Nice, Nice, France
| | - Guillaume Favre
- Department of Nephrology, University Côte d'Azur, University Hospital of Nice, Nice, France.,Department of Nephrology, University Côte d'Azur, Institute for Research on Cancer and Aging of Nice (IRCAN), "Aging and Diabetes" Team, University Hospital of Nice, Nice, France
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Eckart A, Hausfater P, Amin D, Amin A, Haubitz S, Bernard M, Baumgartner A, Struja T, Kutz A, Christ-Crain M, Huber A, Mueller B, Schuetz P. Hyponatremia and activation of vasopressin secretion are both independently associated with 30-day mortality: results of a multicenter, observational study. J Intern Med 2018; 284:270-281. [PMID: 29664160 DOI: 10.1111/joim.12764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hyponatremia is a common feature of acute illness and associated with increased mortality. This may be explained by a stress-mediated activation of the vasopressin system with an increase in free-water reabsorption. OBJECTIVES To investigate whether the association between hyponatremia and mortality could be explained by activation of the vasopressin system. METHODS We prospectively enrolled adult, medical patients seeking emergency care in three centres in Switzerland, France and the United States. We investigated associations between admission plasma sodium and copeptin, a stable portion of the vasopressin-precursor peptide, with 30-day mortality. We performed uni- and multivariate regression analysis. RESULTS Of 6962 included patients, 18% had hyponatremia (sodium ≤135 mmol L-1 ), which doubled their risk for mortality compared to patients with normonatremia (8.3% vs. 3.8%). This association was confirmed in a multivariate-adjusted logistic regression analysis [adjusted odds ratio (OR) 1.47, 95% CI 1.12-1.93, P = 0.005]. Vasopressin levels, mirrored by copeptin, were also increased in nonsurvivors and strongly associated with mortality (adjusted OR 3.42, 95% CI 2.76-4.25, P < 0.001). The association between hyponatremia and mortality remained unchanged when adding copeptin levels to the regression model (fully adjusted OR 1.53, 95% CI 1.16-2.00, P = 0.002). CONCLUSION This prospective study including medical patients upon emergency room admission found hyponatremia as well as an activation of the vasopressin system to be independently associated with mortality. This suggests that stress- and vasopressin-independent mechanisms are responsible for the association of low sodium levels with mortality.
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Affiliation(s)
- A Eckart
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - P Hausfater
- Emergency Department, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,Sorbonne Universités UPMC-Univ Paris06, UMRS INSERM 1166, IHUC, ICAN, Paris, France
| | - D Amin
- Morton Plant Hospital, Clearwater, FL, USA
| | - A Amin
- Morton Plant Hospital, Clearwater, FL, USA
| | - S Haubitz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - M Bernard
- Biochemistry Department, Hôpital Pitié-Salpêtrière and Univ-Paris Descartes, Paris, France
| | - A Baumgartner
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - T Struja
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - A Kutz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - M Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - A Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - B Mueller
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - P Schuetz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
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Müller M, Schefold JC, Guignard V, Exadaktylos AK, Pfortmueller CA. Hyponatraemia is independently associated with in-hospital mortality in patients with pneumonia. Eur J Intern Med 2018; 54:46-52. [PMID: 29657106 DOI: 10.1016/j.ejim.2018.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 03/13/2018] [Accepted: 04/08/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hyponatraemia on hospital admission has been shown to be a risk factor for illness severity in critically ill patients. The aim of the present study was to investigate whether hyponatraemia on emergency department (ED) admission independently influences in-hospital mortality, ICU admission, and/or length of hospitalisation in patients with pneumonia. METHODS 610 patients (64.4% male, median 66 years) diagnosed with pneumonia were identified by retrospective screening of electronic admission data (06/2011-06/2013). Patients were admitted to the ED of Bern University Hospital, Switzerland. Patient characteristics, potential confounders, and patient-centred clinical outcomes, including mortality, ICU admission, and length of hospitalisation, were analysed. Multivariate logistic analysis adjusted for typical confounders was performed to analyse the association of hyponatraemia with clinical outcomes. RESULTS In a large cohort of consecutive acutely admitted patients with pneumonia, the overall in-hospital mortality rate was 12.5%; 21.2% of patients required primary or secondary ICU admission, and the median length of hospital stay was 8 (IQR 5-13) days. At baseline, 47 patients (7.7%) were found to have concomitant hyponatraemia. Multivariate regression revealed a significant association between hyponatraemia and in-hospital mortality (adjusted OR: 2.7, 95% CI: 1.3-5.9, p = 0.010), but not with ICU admission (adjusted OR: 1.8, 95% CI: 0.9-3.6, p = 0.103) or length of hospitalisation (p = 0.493) after adjustment for age, neoplasia, COPD, suspected sepsis, and cardiac disease. The association was robust if controlled for other covariates, e.g. CRB-65 score. CONCLUSIONS Hyponatraemia on admission predicts poor outcome and is an independent risk factor for in-hospital mortality in admitted patients diagnosed with pneumonia.
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Affiliation(s)
- Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Viviane Guignard
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Carmen A Pfortmueller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Temraz S, Tamim H, Mailhac A, Taher A. Could sodium imbalances predispose to postoperative venous thromboembolism? An analysis of the NSQIP database. Thromb J 2018; 16:11. [PMID: 29988709 PMCID: PMC6029156 DOI: 10.1186/s12959-018-0165-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/01/2018] [Indexed: 12/16/2022] Open
Abstract
Background Hyponatremia is common among patients with pulmonary embolism, while hypernatremia increases the risk of venous thromboembolism (VTE). Our objective was to evaluate the association between sodium imbalances and the incidence of VTE and other selected perioperative outcomes. Methods We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and identified 1,108,704 patients undergoing major surgery from 2008 to 2012. We evaluated 30-day perioperative outcomes, including mortality and cardiac, respiratory, neurological, urinary, wound, and VTE outcomes. Multivariate logistic regressions were used to estimate the odds of 30-day perioperative outcomes. Results Compared with the normal sodium group, in which VTE occurred in 1.0% of patients, 1.8% of patients in the hyponatremia group (unadjusted odds ratio (OR) 1.84) and 2.4% of patients in the hypernatremia group (unadjusted OR 2.49) experienced VTE. Crude mortality was 1.3% in the normal sodium group, 4.9% in the hyponatremia group (unadjusted OR 3.93) and 8.4% in the hypernatremia group (unadjusted OR 7.01). Crude composite morbidity was 7.1% for the normal sodium group, 16.7% for the hyponatremia group (unadjusted OR 2.63) and 20.6% for the hypernatremia group (unadjusted OR 3.43). After adjusting for potential confounders, hyponatremia and hypernatremia remained significantly and independently associated with an increased risk of VTE (adjusted OR 1.43 and 1.56, respectively), mortality (adjusted OR 1.39 and 1.39, respectively) and composite morbidity (adjusted OR 2.15 and 3.34, respectively). Conclusions Pre-operative hyponatremia and hypernatremia are potential prognostic markers for perioperative 30-day morbidity, mortality and VTE.
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Affiliation(s)
- Sally Temraz
- 1Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh 110 72020, Beirut, Lebanon
| | - Hani Tamim
- 1Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh 110 72020, Beirut, Lebanon
| | - Aurelie Mailhac
- 2Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Taher
- 1Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh 110 72020, Beirut, Lebanon
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Jahanihashemi H, Babaie M, Bijani S, Bazzazan M, Bijani B. Poverty as an independent risk factor for in-hospital mortality in community-acquired pneumonia: A study in a developing country population. Int J Clin Pract 2018; 72:e13085. [PMID: 29665161 DOI: 10.1111/ijcp.13085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/18/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is one of the most severe lower respiratory tract infections with a high in-hospital mortality. The aim of this study was to investigate the socioeconomic and medical risk factors affecting the prognosis of acute pneumonia. The results of this study can mention the value of socioeconomic backgrounds like poverty and illiteracy in clinical practice, even in a well-known biological phenomenon (eg acute pneumonia). METHODS In this cross-sectional study, all admitted patients to a tertiary teaching hospital with a diagnosis of community acquired pneumonia in a 12-month period were enrolled. Socioeconomic and demographic characteristics, underlying conditions, clinical manifestations and para-clinical test results at admission registered prospectively. A logistic regression model was conducted using in-hospital mortality as the dependent variable. RESULTS A total of 621 patients was included in this study. Among them, 47 patients (7.6%) died during the hospitalisation period. In multiple logistic regression analysis, pleural effusion, a higher CURB-65 score, hyponatremia, hyperglycaemia and poverty (being in the lower economic class) were identified as independent risk factors for in-hospital mortality in community-acquired pneumonia. CONCLUSION Numerous factors can influence the prognosis of CAP. In addition to the CURB-65 score and some other medical risk factors, socioeconomic backgrounds can also affect the early outcome in CAP. In this study, being in the lower economic class (as an indicator of poverty) is interpreted as an independent risk factor for a poor prognosis in CAP.
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Affiliation(s)
- Hassan Jahanihashemi
- Department of Community Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mona Babaie
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Soroush Bijani
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Maryam Bazzazan
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Behzad Bijani
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
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Girardeau Y, Jannot AS, Chatellier G, Saint-Jean O. Association between borderline dysnatremia and mortality insight into a new data mining approach. BMC Med Inform Decis Mak 2017; 17:152. [PMID: 29166900 PMCID: PMC5700671 DOI: 10.1186/s12911-017-0549-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Even small variations of serum sodium concentration may be associated with mortality. Our objective was to confirm the impact of borderline dysnatremia for patients admitted to hospital on in-hospital mortality using real life care data from our electronic health record (EHR) and a phenome-wide association analysis (PheWAS). METHODS Retrospective observational study based on patient data admitted to Hôpital Européen George Pompidou, between 01/01/2008 and 31/06/2014; including 45,834 patients with serum sodium determinations on admission. We analyzed the association between dysnatremia and in-hospital mortality, using a multivariate logistic regression model to adjust for classical potential confounders. We performed a PheWAS to identify new potential confounders. RESULTS Hyponatremia and hypernatremia were recorded for 12.0% and 1.0% of hospital stays, respectively. Adjusted odds ratios (ORa) for severe, moderate and borderline hyponatremia were 3.44 (95% CI, 2.41-4.86), 2.48 (95% CI, 1.96-3.13) and 1.98 (95% CI, 1.73-2.28), respectively. ORa for severe, moderate and borderline hypernatremia were 4.07 (95% CI, 2.92-5.62), 4.42 (95% CI, 2.04-9.20) and 3.72 (95% CI, 1.53-8.45), respectively. Borderline hyponatremia (ORa = 1.57 95% CI, 1.35-1.81) and borderline hypernatremia (ORa = 3.47 95% CI, 2.43-4.90) were still associated with in-hospital mortality after adjustment for classical and new confounding factors identified through the PheWAS analysis. CONCLUSION Borderline dysnatremia on admission are independently associated with a higher risk of in-hospital mortality. By using medical data automatically collected in EHR and a new data mining approach, we identified new potential confounding factors that were highly associated with both mortality and dysnatremia.
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Affiliation(s)
- Yannick Girardeau
- Biomedical Informatics and Public Health Department, Hôpital Européen G. Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1138, Centre de Recherche des Cordeliers, F-75006, Paris, France. .,Division of Geriatrics, Hôpital Européen G. Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Anne-Sophie Jannot
- Biomedical Informatics and Public Health Department, Hôpital Européen G. Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1138, Centre de Recherche des Cordeliers, F-75006, Paris, France
| | - Gilles Chatellier
- Biomedical Informatics and Public Health Department, Hôpital Européen G. Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques, 1418, Paris, France
| | - Olivier Saint-Jean
- Division of Geriatrics, Hôpital Européen G. Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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Cuesta M, Ortolá A, Garrahy A, Calle Pascual AL, Runkle I, Thompson CJ. Predictors of failure to respond to fluid restriction in SIAD in clinical practice; time to re-evaluate clinical guidelines? QJM 2017; 110:489-492. [PMID: 28186579 DOI: 10.1093/qjmed/hcx036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fluid restriction is recommended as first line therapy for Syndrome of Inappropriate Antidiuresis (SIAD), despite of lack of good evidence base to support its use, and poor efficacy in clinical practice and in the literature. AIM We set out to determine how many patients with well-defined SIAD had pre-treatment criteria which would predict failure to fluid restriction. DESIGN AND METHODS This was a consecutive, prospective evaluation of 183 patients with a diagnosis of SIAD in two different hospitals. Full ascertainment of the diagnostic criteria for SIAD was obtained in all patients. RESULTS About 47% of patients had a urine volume <1500 ml in 24 h, 41% had initial urine osmolality > 500 mOsm/kg, 26% a Furst-equation ratio > 1. About 59% had one criterion predicting failure to respond to fluid restriction, 37% two criteria, and 3% three criteria. CONCLUSIONS Our data suggest that up to 60% of patients with SIAD had criteria which recent clinical guidelines suggest would predict nonresponse to fluid restriction. This may explain why the recommended first line therapy for SIAD has been shown to be ineffective.
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Affiliation(s)
- M Cuesta
- Academic Endocrine Unit, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - A Ortolá
- Departamento de Endocrinología y Nutrición Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - A Garrahy
- Academic Endocrine Unit, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - A L Calle Pascual
- Departamento de Endocrinología y Nutrición Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - I Runkle
- Departamento de Endocrinología y Nutrición Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - C J Thompson
- Academic Endocrine Unit, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
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Abstract
Hyponatremia is the commonest electrolyte disorder encountered in clinical practice. It develops when the mechanisms regulating water and electrolyte handling are impaired, which in many instances occur in the setting of concurrent diseases such as heart failure, liver failure, renal failure etc… Hyponatremia as an electrolyte disorder has several specificities: when profound it can be quickly fatal and when moderate it carries a high risk of mortality and morbidity, but at the same time incorrect treatment of profound hyponatremia can lead to debilitating neurological disease and it remains unclear if treatment of moderate hyponatremia is associated with a decrease in mortality and morbidity. A proper diagnosis is the keystone for an adequate treatment for hyponatremia and in the last few years many diagnosis algorithms have been developed to aid in the evaluation of the hyponatremic patient. Also because of the availability of vasopressin receptor antagonists and the advances made in the research regarding complications associated with hyponatremia treatment, new treatment recommendations have been published recently by several panels. This review will discuss the physiopathology, epidemiology, and clinical manifestations of hyponatremia and also the diagnosis and the treatment of this disorder with special emphasis on the complication from overly rapid correction of hyponatremia.
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Sodium Disturbances in Children Admitted to a Kenyan Hospital: Magnitude, Outcome and Associated Factors. PLoS One 2016; 11:e0161320. [PMID: 27603309 PMCID: PMC5014322 DOI: 10.1371/journal.pone.0161320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 08/03/2016] [Indexed: 01/16/2023] Open
Abstract
Background Perturbations of blood sodium are the most frequently encountered electrolyte disorder in sick children, and may influence fluid therapy. We examined the frequency of blood sodium perturbations, and factors and outcomes associated with hyponatremia in children admitted to a rural Kenyan hospital and investigated the risk factors associated with deaths in hyponatremic children. Methods Plasma sodium levels and other laboratory parameters were measured in children admitted to a rural Kenyan hospital. Clinical measurements were collected using standard forms and entered into a computer database. The proportion of children admitted with hyponatremia was determined. Logistic regression models were used to investigate factors associated with hyponatremia, and death in those with hyponatremia. Results Abnormal plasma sodium occurred in 46.6% (95% confidence interval (95%CI) 43.5–49.6%) of 1026 pediatric admissions. Hyponatremia occurred in 44.4% (95%CI 41.4–47.5%) and hypernatremia in 2.1% (95%CI 1.3–3.0%). Malaria (40.8%) was the most common underlying primary diagnosis in hyponatremic children. Malaria, hyperglycemia, wasting, high creatinine levels and preserved consciousness were associated with hyponatremia. Pallor and seizures were associated with increased mortality in hyponatremic children. Conclusions Sodium disturbances are common in pediatric admissions to a County hospital in rural Kenya. Seizures and pallor were predictors of mortality in hyponatremic children.
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Cuesta M, Garrahy A, Thompson CJ. SIAD: practical recommendations for diagnosis and management. J Endocrinol Invest 2016; 39:991-1001. [PMID: 27094044 DOI: 10.1007/s40618-016-0463-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/23/2016] [Indexed: 12/26/2022]
Abstract
Hyponatremia is the commonest electrolyte disturbance encountered in hospitalized patients, and the syndrome of inappropriate antidiuresis (SIAD) is the most frequent underlying disorder. There is a well-recognized relationship between hyponatremia and increased morbidity and mortality. Therefore, to provide appropriate treatment is critical to improve the clinical outcome related to SIAD-hyponatremia. There have been important advances in the treatment of SIAD over the last decade, leading to the publication of several clinical guidelines. In particular, the introduction of the vasopressin-2 receptor antagonists provides a potent pharmacological tool to target the underlying pathophysiology of SIAD. The evidence base recommendations of the available therapies for SIAD are discussed in this study. Fluid restriction is considered the first-line therapy by the recent published guidelines, but it is certainly ineffective or unfeasible in many patients with SIAD. We discuss a number of relevant points to the use of fluid restriction in this study, including the lack of good evidence-based recommendations to support its use. Conversely, the clinical efficacy of oral tolvaptan in SIAD supported by good quality randomized, placebo controlled, clinical trials. However, the cost of the therapy and the need for long-term safety data may limit its widespread use. Finally, new recommendations for the management of acute hyponatremia with a focus on the use of bolus therapy with 3 % hypertonic sodium chloride are described in this study.
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Affiliation(s)
- M Cuesta
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin 9, Ireland
| | - A Garrahy
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin 9, Ireland
| | - C J Thompson
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin 9, Ireland.
- Beaumont Private Clinic, Beaumont Hospital, Dublin 9, Ireland.
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The Economic Burden of Hyponatremia: Systematic Review and Meta-Analysis. Am J Med 2016; 129:823-835.e4. [PMID: 27059386 DOI: 10.1016/j.amjmed.2016.03.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hyponatremia is the most common electrolyte abnormality observed in clinical practice. Several studies have demonstrated that hyponatremia is associated with an increased length of hospital stay and of hospital resource utilization. To clarify the impact of hyponatremia on the length of hospitalization and costs, we performed a meta-analysis based on published studies that compared hospital length of stay and cost between patients with and without hyponatremia. METHODS An extensive Medline, Embase, and Cochrane search was performed to retrieve all studies published up to April 1, 2015 using the following words: "hyponatremia" or "hyponatraemia" AND "hospitalization" or "hospitalisation." A meta-analysis was performed including all studies comparing duration of hospitalization and hospital readmission rate in subjects with and without hyponatremia. RESULTS Of 444 retrieved articles, 46 studies satisfied the inclusion criteria, encompassing a total of 3,940,042 patients; among these, 757,763 (19.2%) were hyponatremic. Across all studies, hyponatremia was associated with a significantly longer duration of hospitalization (3.30 [2.90-3.71; 95% CIs] mean days; P < .000). Similar results were obtained when patients with associated morbidities were analyzed separately. Furthermore, hyponatremic patients had a higher risk of readmission after the first hospitalization (odds ratio 1.32 [1.18-1.48; 95% CIs]; P < .000). A meta-regression analysis showed that the hyponatremia-related length of hospital stay was higher in males (Slope = 0.09 [0.05-0.12; 95% CIs]; P = .000 and Intercept = -1.36 [-3.03-0.32; 95% CIs]; P = .11) and in elderly patients (Slope = 0.002 [0.001-0.003; 95% CIs]; P < .000 and Intercept = 0.89 [0.83-0.97; 95% CIs]; P < .001). A negative association between serum [Na(+)] cutoff and duration of hospitalization was detected. No association between duration of hospitalization, serum [Na(+)], and associated morbidities was observed. Finally, when only US studies (n = 8) were considered, hyponatremia was associated with up to around $3000 higher hospital costs/patient when compared with the cost of normonatremic subjects. CONCLUSIONS This meta-analysis confirms that hyponatremia is associated with a prolonged hospital length of stay and higher risk of readmission. These observations suggest that hyponatremia may represent one important determinant of the hospitalization costs.
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Case control study: magnetic resonance spectroscopy of brain in HIV infected patients. BMC Neurol 2016; 16:99. [PMID: 27405321 PMCID: PMC4942893 DOI: 10.1186/s12883-016-0628-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/22/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In vivo proton magnetic resonance spectroscopy ((1)H-MRS) studies on brain in HIV infected patients have shown significant alteration in neuro-biochemicals. METHODS In this study, we measured the neuro-biochemical metabolites from the left frontal white matter (FWM) and left basal ganglia (BG) caudate head nucleus in 71 subjects that include 30 healthy controls, 20 asymptomatic HIV and 21 HIV patients with CNS lesion. Proton MR spectra were acquired at 3 T MRI system and the concentration (institutional units) of tNAA (N-acetylaspartate, NAA + N-acetylaspartylglutamate, NAAG), tCr (Creatine, Cr + phosphocreatine, PCr), choline containing compounds (tCho), glutamate + glutamine (Glx) and lipid and macromolecules at 0.9 ppm were determined using LC Model. RESULTS In BG, the concentration of tNAA (6.71 ± 0.64) was decreased and in FWM, the concentration of Glx (20.4 ± 7.8), tCr (9.14 ± 3.04) and lipid and macromolecules at 0.9 ppm (8.69 ± 2.96) were increased in HIV patients with CNS lesion. In healthy controls, the concentration of tNAA in BG was 7.31 ± 0.47 and concentration of Glx, tCr and lipid and macromolecules in FWM were 15.0 ± 6.06, 6.95 ± 2.56, 5.59 ± 1.56, respectively. CONCLUSION Reduced tNAA in BG suggests neuronal loss in HIV patients with CNS lesion while increased Glx in FWM may suggest excito-toxicity. In addition, increased levels of tCr in FWM of HIV patients were observed. The study indicates region specific metabolic changes in tNAA, tCr and Glx in brain of HIV infected patients.
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Jamookeeah C, Robinson P, O'Reilly K, Lundberg J, Gisby M, Ländin M, Skov J, Trueman D. Cost-effectiveness of tolvaptan for the treatment of hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone secretion in Sweden. BMC Endocr Disord 2016; 16:22. [PMID: 27184496 PMCID: PMC4867540 DOI: 10.1186/s12902-016-0104-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 05/03/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Tolvaptan is the only vasopressin V2 receptor antagonist licensed by the European Medicines Agency for the treatment of hyponatraemia (HN) secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). We have investigated the cost-effectiveness of tolvaptan versus no active treatment (NAT) in adult patients within the licensed indication who have either failed to respond to fluid restriction or for whom the use of fluid restriction is not suitable, from the societal perspective in Sweden. METHODS A cost-utility analysis, considering a 'general SIADH' population and two subpopulations of patients (small-cell lung cancer [SCLC] and pneumonia) to broadly represent the complex clinical pathway of SIADH, was performed. A discrete event simulation was developed to model the progression of individuals through inpatient admissions over a 30-day time horizon (180 days for the SCLC cohort). Clinical data were derived from tolvaptan trials and observational data sources. All costs are given in Swedish kronor (SEK). RESULTS In the 'general SIADH' population, tolvaptan was associated with reduced costs (SEK 5,779 per patient [€624]) and increased quality-adjusted life-years (QALYs) (0.0019) compared with NAT and was therefore the dominant treatment strategy. Tolvaptan was also associated with reduced costs and increased QALYs in the SCLC and pneumonia subpopulations. The most influential variables in our analysis were reduction in hospital length of stay, duration of treatment and long term treatment with tolvaptan in SCLC patients. CONCLUSIONS Tolvaptan represents a cost-effective treatment option in Sweden for hospitalised patients with HN secondary to SIADH who have either failed to respond to or are unsuitable for fluid restriction.
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Affiliation(s)
- Clare Jamookeeah
- Otsuka Pharmaceutical Europe Ltd., Gallions, Wexham Springs, Framewood Road, Wexham, SL3 6PJ, UK
| | - Paul Robinson
- Otsuka Pharmaceutical Europe Ltd., Gallions, Wexham Springs, Framewood Road, Wexham, SL3 6PJ, UK
| | - Karl O'Reilly
- Otsuka Pharmaceutical Europe Ltd., Gallions, Wexham Springs, Framewood Road, Wexham, SL3 6PJ, UK. KO'
| | | | - Martin Gisby
- Otsuka Pharmaceutical Europe Ltd., Gallions, Wexham Springs, Framewood Road, Wexham, SL3 6PJ, UK
| | | | - Jakob Skov
- Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden
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Kleindienst A, Hannon MJ, Buchfelder M, Verbalis JG. Hyponatremia in Neurotrauma: The Role of Vasopressin. J Neurotrauma 2015; 33:615-24. [PMID: 26472056 DOI: 10.1089/neu.2015.3981] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Hyponatremia is frequent in patients suffering from traumatic brain injury, subarachnoid hemorrhage, or following intracranial procedures, with approximately 20% having a decreased serum sodium concentration to <125 mmol/L. The pathophysiology of hyponatremia in neurotrauma is not completely understood, but in large part is explained by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The abnormal water and/or sodium handling creates an osmotic gradient promoting the shift of water into brain cells, thereby worsening cerebral edema and precipitating neurological deterioration. Unless hyponatremia is corrected promptly and effectively, morbidity and mortality increases through seizures, elevations in intracranial pressure, and/or herniation. The excess mortality in patients with severe hyponatremia (<125 mmol/L) extends beyond the time frame of hospital admission, with a reported mortality of 20% in hospital and 45% within 6 months of follow-up. Current options for the management of hyponatremia include fluid restriction, hypertonic saline, mineralocorticoids, and osmotic diuretics. However, the recent development of vasopressin receptor antagonists provides a more physiological tool for the management of excess water retention and consequent hyponatremia, such as occurs in SIADH. This review summarizes the existing literature on the pathophysiology, clinical features, and management of hyponatremia in the setting of neurotrauma.
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Affiliation(s)
- Andrea Kleindienst
- 1 Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nürenberg , Erlangen, Germany .,2 Department of Neurosurgery, Klinikum Amberg, Amberg, Germany
| | | | - Michael Buchfelder
- 1 Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nürenberg , Erlangen, Germany
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Frangeskou M, Lopez-Valcarcel B, Serra-Majem L. Dehydration in the Elderly: A Review Focused on Economic Burden. J Nutr Health Aging 2015; 19:619-27. [PMID: 26054498 DOI: 10.1007/s12603-015-0491-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dehydration is the most common fluid and electrolyte problem among elderly patients. It is reported to be widely prevalent and costly to individuals and to the health care system. The purpose of this review is to summarize the literature on the economic burden of dehydration in the elderly. METHOD A comprehensive search of several databases from database inception to November 2013, only in English language, was conducted. The databases included Pubmed and ISI Web of Science. The search terms «dehydration» / "hyponaremia" / "hypernatremia" AND «cost» AND «elderly» were used to search for comparative studies of the economic burden of dehydration. A total of 15 papers were identified. RESULTS Dehydration in the elderly is an independent factor of higher health care expenditures. It is directly associated with an increase in hospital mortality, as well as with an increase in the utilization of ICU, short and long term care facilities, readmission rates and hospital resources, especially among those with moderate to severe hyponatremia. CONCLUSIONS Dehydration represents a potential target for intervention to reduce healthcare expenditures and improve patients' quality of life.
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Affiliation(s)
- M Frangeskou
- Dr. Lluis Serra Majem, Research Institute of Biomedical and Health Sciencies, University of Las Palmas de Gran Canaria, PO Box 550; 35080-Las Palmas de Gran Canaria, Spain. Telephone:+34 928 453476 Fax:+34 928 453475 E-mail address:
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Corona G, Giuliani C, Verbalis JG, Forti G, Maggi M, Peri A. Hyponatremia improvement is associated with a reduced risk of mortality: evidence from a meta-analysis. PLoS One 2015; 10:e0124105. [PMID: 25905459 PMCID: PMC4408113 DOI: 10.1371/journal.pone.0124105] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/25/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Hyponatremia is the most common electrolyte disorder and it is associated with increased morbidity and mortality. However, there is no clear demonstration that the improvement of serum sodium concentration ([Na(+)]) counteracts the increased risk of mortality associated with hyponatremia. Thus, we performed a meta-analysis that included the published studies that addressed the effect of hyponatremia improvement on mortality. METHODS AND FINDINGS A Medline, Embase and Cochrane search was performed to retrieve all English-language studies of human subjects published up to June 30th 2014, using the following words: "hyponatremia", "hyponatraemia", "mortality", "morbidity" and "sodium". Fifteen studies satisfied inclusion criteria encompassing a total of 13,816 patients. The identification of relevant abstracts, the selection of studies and the subsequent data extraction were performed independently by two of the authors, and conflicts resolved by a third investigator. Across all fifteen studies, any improvement of hyponatremia was associated with a reduced risk of overall mortality (OR=0.57[0.40-0.81]). The association was even stronger when only those studies (n=8) reporting a threshold for serum [Na(+)] improvement to >130 mmol/L were considered (OR=0.51[0.31-0.86]). The reduced mortality rate persisted at follow-up (OR=0.55[0.36-0.84] at 12 months). Meta-regression analyses showed that the reduced mortality associated with hyponatremia improvement was more evident in older subjects and in those with lower serum [Na(+)] at enrollment. CONCLUSIONS This meta-analysis documents for the first time that improvement in serum [Na(+)] in hyponatremic patients is associated with a reduction of overall mortality.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Corinna Giuliani
- Endocrine Unit, “Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies” (DENOThe), Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Careggi Hospital, 50139, Florence, Italy
| | - Joseph G. Verbalis
- Division of Endocrinology and Metabolism, Georgetown University, Washington, DC, 20007, United States of America
| | - Gianni Forti
- Endocrine Unit, “Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies” (DENOThe), Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Careggi Hospital, 50139, Florence, Italy
| | - Mario Maggi
- Andrology Unit, “Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies” (DENOThe), Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Careggi Hospital, 50139, Florence, Italy
| | - Alessandro Peri
- Endocrine Unit, “Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies” (DENOThe), Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Careggi Hospital, 50139, Florence, Italy
- * E-mail:
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Behan LA, Sherlock M, Moyles P, Renshaw O, Thompson CJT, Orr C, Holte K, Salehmohamed MR, Glynn N, Tormey W, Thompson CJ. Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study. Eur J Endocrinol 2015; 172:243-50. [PMID: 25430399 DOI: 10.1530/eje-14-0719] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT AND OBJECTIVE Patients with cranial diabetes insipidus (CDI) are at risk of developing both hypernatraemia and hyponatraemia, due to the condition itself or secondary to treatment with vasopressin-analogues or during administration of i.v. fluids. We aimed to assess the frequency and impact of dysnatraemias in the inpatient (INPT) and outpatient (OPT) setting in desmopressin-treated CDI, comparing those with normal thirst with those with abnormal thirst. DESIGN The study included 192 patients with cranial diabetes, who were identified from the Beaumont Pituitary Database, a tertiary referral centre. Retrospective case note audit was performed and the clinical and biochemical information of 147 patients with CDI were available for analysis. RESULTS A total of 4142 plasma sodium measurements for 137 patients with normal thirst, and 385 plasma sodium measurements for ten patients with abnormal thirst were analysed. In those with normal thirst, the most common OPT abnormality was mild hyponatraemia (pNa(+) 131-134 mmol/l) in 27%, while 14.6% had more significant hyponatraemia (pNa(+) ≤130 mmol/l). Of those patients with normal thirst, 5.8% were admitted due to complications directly related to hyponatraemia. Compared with patients with normal thirst, those with abnormal thirst were more likely to develop significant OPT hypernatraemia (20% vs 1.4%, P=0.02) and significant INPT hyponatraemia (50% vs 11.1%, P 0.02). CONCLUSION OPT management of CDI is complicated by a significant incidence of hyponatraemia. In contrast, OPT hypernatraemia is almost exclusively a complication seen in adipsic CDI, who also had more frequent INPT hyponatraemia. CDI associated with thirst disorder requires increased physician attention and patient awareness of potential complications.
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Affiliation(s)
- L A Behan
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - M Sherlock
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - P Moyles
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - O Renshaw
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - C J T Thompson
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - C Orr
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - K Holte
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - M R Salehmohamed
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - N Glynn
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - W Tormey
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - C J Thompson
- Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
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