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

Chloe C A Grim; Fabian Termorshuizen; Robert J Bosman; Olaf L Cremer; Arend Jan Meinders; Maarten W N Nijsten; Peter Pickkers; Angelique M E de Man; Marcus J Schultz; Peter van Vliet; Joachim D Weigel; Hendrik J F Helmerhorst; Nicolette F de Keizer; Evert de Jonge

doi:10.1097/CCM.0000000000005173

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

Chloe C A Grim, Fabian Termorshuizen, Robert J Bosman, Olaf L Cremer, Arend Jan Meinders, Maarten W N Nijsten, Peter Pickkers, Angelique M E de Man, Marcus J Schultz, Peter van Vliet, Joachim D Weigel, Hendrik J F Helmerhorst, Nicolette F de Keizer, Evert de Jonge

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Abstract

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

DESIGN: Retrospective cohort study.

SETTING: Ten Dutch ICUs between January 2011 and April 2017.

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

INTERVENTIONS: None.

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

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

Original language	English
Pages (from-to)	2070-2079
Number of pages	10
Journal	Critical care medicine
Volume	49
Issue number	12
Early online date	24 Jun 2021
DOIs	https://doi.org/10.1097/CCM.0000000000005173
Publication status	Published - 1 Dec 2021

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Grim, C. C. A., Termorshuizen, F., Bosman, R. J., Cremer, O. L., Meinders, A. J., Nijsten, M. W. N., Pickkers, P., de Man, A. M. E., Schultz, M. J., van Vliet, P., Weigel, J. D., Helmerhorst, H. J. F., de Keizer, N. F., & de Jonge, E. (2021). Association Between an Increase in Serum Sodium and In-Hospital Mortality in Critically Ill Patients. Critical care medicine, 49(12), 2070-2079. https://doi.org/10.1097/CCM.0000000000005173

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title = "Association Between an Increase in Serum Sodium and In-Hospital Mortality in Critically Ill Patients",

abstract = "OBJECTIVES: In critically ill patients, dysnatremia is common, and in these patients, in-hospital mortality is higher. It remains unknown whether changes of serum sodium after ICU admission affect mortality, especially whether normalization of mild hyponatremia improves survival.DESIGN: Retrospective cohort study.SETTING: Ten Dutch ICUs between January 2011 and April 2017.PATIENTS: Adult patients were included if at least one serum sodium measurement within 24 hours of ICU admission and at least one serum sodium measurement 24-48 hours after ICU admission were available.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: A logistic regression model adjusted for age, sex, and Acute Physiology and Chronic Health Evaluation-IV-predicted mortality was used to assess the difference between mean of sodium measurements 24-48 hours after ICU admission and first serum sodium measurement at ICU admission (Δ48 hr-[Na]) and in-hospital mortality. In total, 36,660 patients were included for analysis. An increase in serum sodium was independently associated with a higher risk of in-hospital mortality in patients admitted with normonatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.61 [1.44-1.79], Δ48 hr-[Na] > 10 mmol/L odds ratio: 4.10 [3.20-5.24]) and hypernatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.47 [1.02-2.14], Δ48 hr-[Na] > 10 mmol/L odds ratio: 8.46 [3.31-21.64]). In patients admitted with mild hyponatremia and Δ48 hr-[Na] greater than 5 mmol/L, no significant difference in hospital mortality was found (odds ratio, 1.11 [0.99-1.25]).CONCLUSIONS: An increase in serum sodium in the first 48 hours of ICU admission was associated with higher in-hospital mortality in patients admitted with normonatremia and in patients admitted with hypernatremia.",

author = "Grim, \{Chloe C A\} and Fabian Termorshuizen and Bosman, \{Robert J\} and Cremer, \{Olaf L\} and Meinders, \{Arend Jan\} and Nijsten, \{Maarten W N\} and Peter Pickkers and \{de Man\}, \{Angelique M E\} and Schultz, \{Marcus J\} and \{van Vliet\}, Peter and Weigel, \{Joachim D\} and Helmerhorst, \{Hendrik J F\} and \{de Keizer\}, \{Nicolette F\} and \{de Jonge\}, Evert",

year = "2021",

month = dec,

day = "1",

doi = "10.1097/CCM.0000000000005173",

language = "English",

volume = "49",

pages = "2070--2079",

journal = "Critical care medicine",

issn = "0090-3493",

publisher = "Lippincott Williams \& Wilkins",

number = "12",

}

Grim, CCA, Termorshuizen, F, Bosman, RJ, Cremer, OL, Meinders, AJ, Nijsten, MWN, Pickkers, P, de Man, AME, Schultz, MJ, van Vliet, P, Weigel, JD, Helmerhorst, HJF, de Keizer, NF & de Jonge, E 2021, 'Association Between an Increase in Serum Sodium and In-Hospital Mortality in Critically Ill Patients', Critical care medicine, vol. 49, no. 12, pp. 2070-2079. https://doi.org/10.1097/CCM.0000000000005173

TY - JOUR

T1 - Association Between an Increase in Serum Sodium and In-Hospital Mortality in Critically Ill Patients

AU - Grim, Chloe C A

AU - Termorshuizen, Fabian

AU - Bosman, Robert J

AU - Cremer, Olaf L

AU - Meinders, Arend Jan

AU - Nijsten, Maarten W N

AU - Pickkers, Peter

AU - de Man, Angelique M E

AU - Schultz, Marcus J

AU - van Vliet, Peter

AU - Weigel, Joachim D

AU - Helmerhorst, Hendrik J F

AU - de Keizer, Nicolette F

AU - de Jonge, Evert

PY - 2021/12/1

Y1 - 2021/12/1

N2 - OBJECTIVES: In critically ill patients, dysnatremia is common, and in these patients, in-hospital mortality is higher. It remains unknown whether changes of serum sodium after ICU admission affect mortality, especially whether normalization of mild hyponatremia improves survival.DESIGN: Retrospective cohort study.SETTING: Ten Dutch ICUs between January 2011 and April 2017.PATIENTS: Adult patients were included if at least one serum sodium measurement within 24 hours of ICU admission and at least one serum sodium measurement 24-48 hours after ICU admission were available.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: A logistic regression model adjusted for age, sex, and Acute Physiology and Chronic Health Evaluation-IV-predicted mortality was used to assess the difference between mean of sodium measurements 24-48 hours after ICU admission and first serum sodium measurement at ICU admission (Δ48 hr-[Na]) and in-hospital mortality. In total, 36,660 patients were included for analysis. An increase in serum sodium was independently associated with a higher risk of in-hospital mortality in patients admitted with normonatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.61 [1.44-1.79], Δ48 hr-[Na] > 10 mmol/L odds ratio: 4.10 [3.20-5.24]) and hypernatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.47 [1.02-2.14], Δ48 hr-[Na] > 10 mmol/L odds ratio: 8.46 [3.31-21.64]). In patients admitted with mild hyponatremia and Δ48 hr-[Na] greater than 5 mmol/L, no significant difference in hospital mortality was found (odds ratio, 1.11 [0.99-1.25]).CONCLUSIONS: An increase in serum sodium in the first 48 hours of ICU admission was associated with higher in-hospital mortality in patients admitted with normonatremia and in patients admitted with hypernatremia.

AB - OBJECTIVES: In critically ill patients, dysnatremia is common, and in these patients, in-hospital mortality is higher. It remains unknown whether changes of serum sodium after ICU admission affect mortality, especially whether normalization of mild hyponatremia improves survival.DESIGN: Retrospective cohort study.SETTING: Ten Dutch ICUs between January 2011 and April 2017.PATIENTS: Adult patients were included if at least one serum sodium measurement within 24 hours of ICU admission and at least one serum sodium measurement 24-48 hours after ICU admission were available.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: A logistic regression model adjusted for age, sex, and Acute Physiology and Chronic Health Evaluation-IV-predicted mortality was used to assess the difference between mean of sodium measurements 24-48 hours after ICU admission and first serum sodium measurement at ICU admission (Δ48 hr-[Na]) and in-hospital mortality. In total, 36,660 patients were included for analysis. An increase in serum sodium was independently associated with a higher risk of in-hospital mortality in patients admitted with normonatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.61 [1.44-1.79], Δ48 hr-[Na] > 10 mmol/L odds ratio: 4.10 [3.20-5.24]) and hypernatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.47 [1.02-2.14], Δ48 hr-[Na] > 10 mmol/L odds ratio: 8.46 [3.31-21.64]). In patients admitted with mild hyponatremia and Δ48 hr-[Na] greater than 5 mmol/L, no significant difference in hospital mortality was found (odds ratio, 1.11 [0.99-1.25]).CONCLUSIONS: An increase in serum sodium in the first 48 hours of ICU admission was associated with higher in-hospital mortality in patients admitted with normonatremia and in patients admitted with hypernatremia.

UR - https://www.scopus.com/pages/publications/85122048479

U2 - 10.1097/CCM.0000000000005173

DO - 10.1097/CCM.0000000000005173

M3 - Article

C2 - 34166287

SN - 0090-3493

VL - 49

SP - 2070

EP - 2079

JO - Critical care medicine

JF - Critical care medicine

IS - 12

ER -

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

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