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      Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

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      About Blood Purification: 3.0 Impact Factor I 5.6 CiteScore I 0.83 Scimago Journal & Country Rank (SJR)

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      Dysnatremias and Survival in Adult Burn Patients: A Retrospective Analysis

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          Abstract

          Background/Aims: Dysnatremias have been evaluated in many populations and have been found to be significantly associated with mortality. However, this relationship has not been well described in the burn population. Methods: Admissions to the burn center at our institution from January 2003 to December 2008 were examined. Independent variables included gender, age, percentage total body surface area burned (%TBSA), percentage of third-degree burn, inhalation injury, injury severity score (ISS), Acute Kidney Injury Network (AKIN) stage, hypernatremia, and hyponatremia. They were examined via Cox proportional hazard regression models against death. Moderate to severe hypo- and hypernatremia were defined as serum sodium <130 and >150 mmol/l, respectively. Results: In 1,969 subjects with a mean age of 36.3 ± 16.4 years, a median %TBSA of 9 (interquartile range 4–20) and a median ISS of 5 (interquartile range 1–16) hypernatremia occurred in 9.9% (n = 194), while hyponatremia occurred in 6.8% (n = 134) with mortality rates of 33.5 and 13.8%, respectively. Patients without a dysnatremia had a mortality rate of 4.3%. On Cox proportional hazard regression age, %TBSA, ISS, and AKIN stage were found to be significant predictors of mortality. Hypernatremia (HR 2.00, 95% CI 1.212–3.31; p = 0.0066), but not hyponatremia (HR 1.72, 95% CI 0.89–3.34; p = 0.1068) was associated with mortality. Conclusions: In the burn population, hypernatremia, but not hyponatremia, is an independent predictor of mortality.

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          Incidence and prognosis of dysnatremias present on ICU admission.

          Philipp G H Metnitz, Christoph Schwarz, Georg-Christian Funk … (2010)
          Dysnatremias are common in patients admitted to the intensive care unit (ICU). Whether the presence of disorders of sodium balance on ICU admission is independently associated with excess mortality is unknown. We hypothesized that dysnatremias at the time of ICU admission are independent risk factors for increased mortality in critically ill patients. We conducted a retrospective study in 77 medical, surgical, and mixed ICUs in Austria, with a database of 151,486 adults admitted consecutively over a period of 10 years (1998-2007). Most patients (114,170, 75.4%) had normal sodium levels (135 155 mmol/L) were 5.1%, 1.2%, and 0.6%, respectively. All types and grades of dysnatremia were associated with increased raw and risk-adjusted hospital mortality ratios. Multiple logistic regression analysis showed an independent mortality risk rising with increasing severity of both hyponatremia and hypernatremia. Odds ratios and 95% confidence interval (CI) for borderline, mild, and severe hyponatremia were 1.32 (1.25-1.39), 1.89 (1.71-2.09), and 1.81 (1.56-2.10), respectively. Odds ratios and 95% CI for borderline, mild, and severe hypernatremia were 1.48 (1.36-1.61), 2.32 (1.98-2.73), and 3.64 (2.88-4.61), respectively. Our results suggest that both hypo- and hypernatremia present on admission to the ICU are independent risk factors for poor prognosis.
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            Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes.

            Maulik S. Doshi, Pankaj Shah, Amit Lahoti … (2012)
            Hyponatremia is the most common electrolyte abnormality in clinical practice, yet little is known about its frequency in patients with cancer or its impact on their clinical outcomes. Retrospective analysis of prospectively collected data. Patients with cancer admitted to the University of Texas M.D. Anderson Cancer Center in 2006 for 3 months. Serum sodium levels categorized as eunatremia (serum sodium, 135-147 mEq/L) and mild (134-130 mEq/L), moderate (129-120 mEq/L), and severe (<120 mEq/L) hyponatremia. (1) Length of hospital stay and (2) 90-day mortality. In 4,702 admissions in 3,357 patients with cancer, hyponatremia (serum sodium <135 mEq/L) was noted in 47% of admissions. It was mild in 36%, moderate in 10%, and severe in 1%. Hyponatremia was acquired during the hospital stay in 24%. Using the first admission data, mean length of stay was 5.6 ± 5.0 days for patients with eunatremia and 9.9 ± 9.2, 13.0 ± 14.1, and 11.5 ± 12.6 days for those with mild, moderate, and severe hyponatremia, respectively. The respective HRs in the multivariate Cox model for longer hospital stay, using patients with eunatremia as reference, were 1.92 (95% CI, 1.75-2.13; P < 0.01), 2.94 (95% CI, 2.56-3.45; P < 0.01), and 2.32 (95% CI, 1.32-4.00; P = 0.01). 283 (8.4%) deaths occurred during 90 days, and in the multivariate model, the respective HRs for 90-day mortality for mild, moderate, and severe hyponatremia were 2.04 (95% CI, 1.42-2.91; P < 0.01); 4.74 (95% CI, 3.21-7.01; P < 0.01), and 3.46 (95% CI, 1.05-11.44; P = 0.04). These findings were consistent when analyses were repeated with sodium levels in tertiles. Observational study, retrospective, inability to adjust for all comorbid conditions. Hyponatremia in patients with cancer is associated with longer hospital stay and higher mortality. Whether long-term correction of hyponatremia would improve these outcomes remains to be determined. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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              Mortality and serum sodium: do patients die from or with hyponatremia?

              Richard Sterns, Sagar Nigwekar, Arun Chawla … (2011)
              Severe hyponatremia (<120 mEq/L) in hospitalized patients has a high mortality rate. We hypothesized that underlying diseases causing hyponatremia attribute to mortality rather than hyponatremia itself. The relationship between mortality and serum sodium (sNa) was examined in 45,693 patients admitted to a single community teaching hospital between January 1996 and December 2007. We conducted a comprehensive retrospective review of the medical records of 53 patients who died after developing sNa <120 mEq/L before or after admission and of 32 patients who survived after developing sNa <110 mEq/L. Mortality rates tended to increase as the sNa fell from 134 to 120 mEq/L, rising above 10% for patients with sNa of 120 to 124 mEq/L. However, below sNa of 120 mEq/L, the trend reversed, such that the mortality rate progressively decreased as sNa fell. More than two thirds of patients who died after sNa <120 mEq/L had at least two additional acute severe progressive illnesses, most commonly sepsis and multiorgan failure. Three deaths (5.6%) in 12 years could plausibly be related to adverse consequences of hyponatremia, and one (1.8% of the fatal cases and 0.15% of all patients with sNa <120 mEq/L) was from cerebral edema. Most patients who survived with sNa <110 mEq/L had medication-induced hyponatremia. Severe underlying illnesses were uncommon in this group. The nature of underlying illness rather than the severity of hyponatremia best explains mortality associated with hyponatremia. Neurologic complications from hyponatremia are uncommon among patients who die with hyponatremia. Copyright © 2011 by the American Society of Nephrology
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                Author and article information

                Journal
                Journal ID (publisher-id): AJN
                Journal ID (nlm-ta): Am J Nephrol
                Journal ID (doi): 10.1159/issn.0250-8095
                Title: American Journal of Nephrology
                Publisher: S. Karger AG
                ISSN (Print): 0250-8095
                ISSN (Electronic): 1421-9670
                Publication date Subscription-year: 2013
                Publication date (Print): February 2013
                Publication date (Electronic): 11 January 2013
                Volume: 37
                Issue: 1
                Pages: 59-64
                Affiliations
                aSan Antonio Military Medical Center, Fort Sam Houston, Tex., bSan Antonio Kidney Disease Center, San Antonio, Tex., cUnited States Army Institute of Surgical Research, Fort Sam Houston, Tex., and dUniformed Services University of the Health Sciences, Bethesda, Md., USA
                Author notes
                *Ian J. Stewart, MD, San Antonio Military Medical Center, ATTN: Nephrology, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234 (USA), E-Mail ian.stewart@amedd.army.mil
                Article
                Publisher ID: 346206 Other ID: Am J Nephrol 2013;37:59–64
                DOI: 10.1159/000346206
                PubMed ID: 23327805
                SO-VID: bf0fd584-fa78-4d1d-b351-59b3e37e4c74
                Copyright © © 2013 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 14 July 2012
                Date accepted : 30 November 2012
                Page count
                Tables: 4, Pages: 6
                Categories
                Subject: Original Report: Patient-Oriented, Translational Research

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Acute kidney injury,Burn,Hyponatremia,Hypernatremia,Dysnatremia,Mortality
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Acute kidney injury, Burn, Hyponatremia, Hypernatremia, Dysnatremia, Mortality

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