May 11, 2022Kidney36039 citationsOpen Access

Hypernatremia in Hospitalized Patients: A Large Population-Based Study

SASoraya Arzhan MRMaria‐Eleni Roumelioti ILIgor Litvinovich

Structured PICO

Does hypernatremia at hospital admission increase the risk of in-hospital mortality and adverse discharge disposition in hospitalized adults?

Population

1,963,020 hospitalized adults (age ≥18 years) with first serum sodium drawn within 24 hours of admission, mean age 58.2, 53% female. Excluded patients with Na <135 mEq/L, missing eGFR/Na, or discharge dispositions other than home, hospice, or nursing facility.

Intervention

Hypernatremia at hospital admission (serum sodium >145 mEq/L, categorized into mild [>145-150 mEq/L], moderate [>150-155 mEq/L], and severe [>155 mEq/L])

Comparator

Normonatremia at hospital admission (serum sodium 135-145 mEq/L)

Outcome

In-hospital mortality, discharge disposition of hospitalized patients (hospice, nursing facility, or home), and length of stayhard clinical

Hypernatremia at hospital admission is strongly and independently associated with increased in-hospital mortality and discharge to a hospice or nursing facility, with risk magnified at lower eGFR and older age.

Abstract

Key Points Hypernatremia has been studied less than hyponatremia and may serve as an important predictor of outcomes among hospitalized patients. This work addresses a key gap regarding outcomes of hypernatremia by assessing the relationship of hypernatremia to outcomes by eGFR or age groups. Hypernatremia was significantly associated with in-hospital mortality and discharge to a hospice or nursing facility. Background Hypernatremia is a frequently encountered electrolyte disorder in hospitalized patients. Controversies still exist over the relationship between hypernatremia and its outcomes in hospitalized patients. This study examines the relationship of hypernatremia to outcomes among hospitalized patients and the extent to which this relationship varies by kidney function and age. Methods We conducted an observational study to investigate the association between hypernatremia, eGFR, and age at hospital admission and in-hospital mortality, and discharge dispositions. We analyzed the data of 1.9 million patients extracted from the Cerner Health Facts databases (2000–2018). Adjusted multinomial regression models were used to estimate the relationship of hypernatremia to outcomes of hospitalized patients. Results Of all hospitalized patients, 3% had serum sodium (Na) >145 mEq/L at hospital admission. Incidence of in-hospital mortality was 12% and 2% in hyper- and normonatremic patients, respectively. The risk of all outcomes increased significantly for Na >155 mEq/L compared with the reference interval of Na=135–145 mEq/L. Odds ratios (95% confidence intervals) for in-hospital mortality and discharge to a hospice or nursing facility were 34.41 (30.59–38.71), 21.14 (17.53–25.5), and 12.21 (10.95–13.61), respectively (all P 155 mEq/L. This work demonstrates that hypernatremia is an important factor related to discharge disposition and supports the need to study whether protocolized treatment of hypernatremia improves outcomes.

Demander à l'IA

Bookmark

View Full Paper