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Eur J Endocrinol. 2016 Dec;175(6):499-507. Epub 2016 Sep 1.

Long-term outcome of profound hyponatremia: a prospective 12 months follow-up study.

Author information

1
EndocrinologyDiabetology and Metabolism, University Hospital Basel, Basel, Switzerland Bettina.winzeler@usb.ch.
2
Department of Clinical ResearchUniversity Hospital Basel, Basel, Switzerland.
3
EndocrinologyDiabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
4
Division of EndocrinologyDiabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
5
NephrologyDialysis & Transplantation, Kantonsspital Aarau, Aarau, Switzerland.
6
Institute of Laboratory MedicineKantonsspital Aarau, Aarau, Switzerland.

Abstract

BACKGROUND:

Hyponatremia is the most common electrolyte abnormality in hospitalized patients and given its impact on mortality and morbidity, a relevant medical condition. Nevertheless, little is known about factors influencing long-term outcome.

METHODS:

This is a prospective observational 12-month follow-up study of patients with profound hyponatremia (≤125 mmol/L) admitted to the emergency department of two tertiary care centers between 2011 and 2013. We analyzed the predictive value of clinical and laboratory parameters regarding the following outcomes: 1-year mortality, rehospitalization and recurrent profound hyponatremia.

RESULTS:

Median (IQR) initial serum sodium (s-sodium) level of 281 included patients was 120 mmol/L (116-123). During the follow-up period, 58 (20.6%) patients died. The majority (56.2%) were rehospitalized at least once. Recurrent hyponatremia was observed in 42.7%, being profound in 16%. Underlying comorbidities, assessed by the Charlson Comorbidity Index, predicted 1-year mortality (odds ratio (OR) 1.43, 95% confidence interval (CI) 1.25-1.64, P < 0.001). Furthermore, 's-sodium level at admission' (OR 1.14, 95% CI 1.01-1.29, P = 0.036) and 'correction of hyponatremia' defined as s-sodium ≥135 mmol/L at discharge were associated with mortality (OR 0.47, 95% CI 0.23-0.94, P = 0.034). Mortality rate fell with decreasing baseline s-sodium levels and was lower in the hyponatremia category ≤120 mmol/L vs >120 mmol/L (14.8% and 27.8%, P < 0.01). Patients with s-sodium level ≤120 mmol/L were more likely to have drug-induced hyponatremia, whereas hypervolemic hyponatremia was more common in patients with s-sodium >120 mmol/L.

CONCLUSION:

Hyponatremia is associated with a substantial 1-year mortality, recurrence and rehospitalization rate. The positive correlation of s-sodium and mortality emphasizes the importance of the underlying disease, which determines the outcome besides hyponatremia itself.

PMID:
27585594
DOI:
10.1530/EJE-16-0500
[Indexed for MEDLINE]

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