Intensive care unit-acquired hypernatremia is an independent predictor of increased mortality and length of stay

Abstract

Purpose: The purpose of this study is to examine the impact of hypernatremia acquired after intensive care unit (ICU) admission on mortality and length of stay (LOS).

Materials and methods: Data for this observational study were collected from patients admitted between January 1, 2008, and September 30, 2010 to 344 ICUs in the eICU Research Institute.

Results: Of the 207702 eligible patients, 8896 (4.3%) developed hypernatremia (serum Na >149 mEq/L). Hospital mortality was 32% for patients with hypernatremia and 11% for patients without hypernatremia (P < .0001). Intensive care unit LOS was 13.7 ± 9.7 days for patients with hypernatremia and 5.1 ± 4.6 for patients without hypernatremia (P < .0001). Multivariate analysis showed that hypernatremia was an independent risk factor for hospital mortality with a relative risk (RR) of 1.40 (95% confidence interval, 1.34-1.45) and ICU LOS with a rate ratio (RtR) of 1.28 (1.26-1.30). The RR for mortality and RtR for ICU LOS increased with increasing severity strata of hypernatremia, but the duration of hypernatremia was not associated with mortality.

Conclusions: Hypernatremia developed following ICU admission in 4.3% of patients. Hypernatremia was independently associated with a 40% increase in risk for hospital mortality and a 28% increase in ICU LOS. Severity, but not duration of ICU-acquired hypernatremia was associated with hospital mortality.

Keywords: Critical care; Hypernatremia; ICU; Mortality; Sodium.