Mortality after hospitalization with mild, moderate, and severe hyponatremia

Abstract

Background: Hyponatremia is the most common electrolyte abnormality in hospitalized individuals.

Methods: To investigate the association between serum sodium concentration and mortality, we conducted a prospective cohort study of 98,411 adults hospitalized between 2000 and 2003 at 2 teaching hospitals in Boston, Massachusetts. The main outcome measures were in-hospital, 1-year, and 5-year mortality. Multivariable logistic regression and Cox proportional hazards models were used to compare outcomes in patients with varying degrees of hyponatremia against those with normal serum sodium concentration.

Results: Hyponatremia (serum sodium concentration <135 mEq/L) was observed in 14.5% of patients on initial measurement. Compared with patients with normonatremia (135-144 mEq/L), those with hyponatremia were older (67.0 vs 63.1 years, P <.001) and had more comorbid conditions (mean Deyo-Charlson Index 1.9 vs 1.4, P <.001). In multivariable-adjusted models, patients with hyponatremia had an increased risk of death in hospital (odds ratio 1.47, 95% confidence interval [CI], 1.33-1.62), at 1 year (hazard ratio 1.38, 95% CI, 1.32-1.46), and at 5 years (hazard ratio 1.25, 95% CI, 1.21-1.30). The increased risk of death was evident even in those with mild hyponatremia (130-134 mEq/L; odds ratio 1.37, 95% CI, 1.23-1.52). The relationship between hyponatremia and mortality was pronounced in patients admitted with cardiovascular disease, metastatic cancer, and those admitted for procedures related to the musculoskeletal system. Resolution of hyponatremia during hospitalization attenuated the increased mortality risk conferred by hyponatremia.

Conclusion: Hyponatremia, even when mild, is associated with increased mortality.

Figure

Odds ratios for death in patients with versus without hyponatremia, according to clinical subgroups. Values above one represent a higher risk of death in those with hyponatremia. Odds ratio point estimates are listed above each box, and 95% confidence intervals are represented by solid lines. P values for interaction terms between hyponatremia (Na <135) and the subgroup of interest were as follows: acute myocardial infarction .30, congestive heart failure .57, sepsis .0002, pneumonia <.0001, chronic kidney disease .67, liver disease .004, gastrointestinal bleeding .18, volume depletion .07, metastatic cancer .005, circulatory system (surgical) .69, circulatory system (medical) .02, musculoskeletal system (surgical) .01, nervous system (surgical) .73, nervous system (medical) .26, respiratory system (medical) .002.