Sodium Fluctuations and Mortality in a General Hospitalized Population

Background/Aims: Aim of our study was to describe the association between natremia (Na) fluctuation and hospital mortality in a general population admitted to a tertiary medical center. Methods: We performed a retrospective observational cohort study on the patient population admitted to the Fondazi...

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Bibliographic Details
Published in:Kidney & blood pressure research 2019-08, Vol.44 (4), p.604-614
Main Authors: Lombardi, Gianmarco, Ferraro, Pietro Manuel, Calvaruso, Luca, Naticchia, Alessandro, D’Alonzo, Silvia, Gambaro, Giovanni
Format: Article
Language:English
Subjects:
Adult
Aged
Cardiovascular diseases
Cerebrovascular diseases
Clinical outcomes
Cohort Studies
Collaboration
Comorbidity
Congestive heart failure
Coronary artery disease
Death
Dementia
Dementia disorders
Diabetes
Electrolytes
Endocrinology
Epidemiology
Female
Glomerular filtration rate
Hazard identification
Health care facilities
Heart
Heart failure
Hospital Mortality
Hospitalization
Hospitals
Humans
Hyperglycemia
Hypernatremia
Hyponatremia
Intensive care
Kidney diseases
Male
Middle Aged
Mortality
Nephrology
Patients
Physiology
Population studies
Prognosis
Proportional Hazards Models
Quartiles
Renal failure
Research Article
Retrospective study
Sodium
Sodium - metabolism
Statistical models
Survival analysis
Vascular diseases
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Summary:Background/Aims: Aim of our study was to describe the association between natremia (Na) fluctuation and hospital mortality in a general population admitted to a tertiary medical center. Methods: We performed a retrospective observational cohort study on the patient population admitted to the Fondazione Policlinico A. Gemelli IRCCS Hospital between January 2010 and December 2014 with inclusion of adult patients with at least 2 Na values available and with a normonatremic condition at hospital admission. Patients were categorized according to all Na values recorded during hospital stay in the following groups: normonatremia, hyponatremia, hypernatremia, and mixed dysnatremia. The difference between the highest or the lowest Na value reached during hospital stay and the Na value read at hospital admission was used to identify the maximum Na fluctuation. Cox proportional hazards models were used to estimate hazard ratios (HRs) for in-hospital death in the groups with dysnatremias and across quartiles of Na fluctuation. Covariates assessed were age, sex, highest and lowest Na level, Charlson/Deyo score, cardiovascular diseases, cerebrovascular diseases, dementia, congestive heart failure, severe kidney disease, estimated glomerular filtration rate, and number of Na measurements during hospital stay. Results: 46,634 admissions matched inclusion criteria. Incident dysnatremia was independently associated with in-hospital mortality (hyponatremia: HR 3.11, 95% CI 2.53, 3.84, p < 0.001; hypernatremia: HR 5.12, 95% CI 3.94, 6.65, p < 0.001; mixed-dysnatremia: HR 4.94, 95% CI 3.08, 7.92, p < 0.001). We found a higher risk of in-hospital death by linear increase of quartile of Na fluctuation (p trend
ISSN:1420-4096
1423-0143
DOI:10.1159/000500916