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. 2016 Jul 29:16:564.
doi: 10.1186/s12885-016-2610-9.

The occurrence of hyponatremia and its importance as a prognostic factor in a cross-section of cancer patients

Jorge J Castillo  1 , Ilya G Glezerman  2 , Susan H Boklage  3 , Joseph Chiodo 3rd  3 , Beni A Tidwell  4 , Lois E Lamerato  5 , Kathy L Schulman  4
Affiliations

The occurrence of hyponatremia and its importance as a prognostic factor in a cross-section of cancer patients

Jorge J Castillo et al. BMC Cancer. .

Abstract

Background: Hyponatremia is prognostic of higher mortality in some cancers but has not been well studied in others. We used a longitudinal design to determine the incidence and prognostic importance of euvolemic and hypervolemic hyponatremia in patients following diagnosis with lymphoma, breast (BC), colorectal (CRC), small cell lung (SCLC), or non-small cell lung cancer (NSCLC).

Methods: Medical record and tumor registry data from two large integrated delivery networks were combined for patients diagnosed with lymphoma, BC, CRC, or lung cancers (2002-2010) who had ≥1 administration of radiation/chemotherapy within 6 months of diagnosis and no evidence of hypovolemic hyponatremia. Hyponatremia incidence was measured per 1000 person-years (PY). Cox proportional hazard models assessed the prognostic value of hyponatremia as a time-varying covariate on overall survival (OS) and progression-free survival (PFS).

Results: Hyponatremia incidence (%, rate) was 76 % each, 1193 and 2311 per 1000 PY, among NSCLC and SCLC patients, respectively; 37 %, 169 in BC; 64 %, 637 in CRC, and 60 %, 395 in lymphoma. Hyponatremia was negatively associated with OS in BC (HR 3.7; P = <.01), CRC (HR 2.4; P < .01), lung cancer (HR 2.4; P < .01), and lymphoma (HR 4.5; P < .01). Hyponatremia was marginally associated with shorter PFS (HR 1.3, P = .07) across cancer types.

Conclusions: The incidence of hyponatremia is higher than previously reported in lung cancer, is high in lymphoma, BC, and CRC and is a negative prognostic indicator for survival. Hyponatremia incidence in malignancy may be underestimated. The effects of hyponatremia correction on survival in cancer patients require further study.

Keywords: Cancer; Euvolemic; Hypervolemic; Hyponatremia; Survival.

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Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Proportion of patients with hyponatremia, by hyponatremia severity and cancer type
Fig. 3
Fig. 3
Kaplan Meier plot of overall survival across cancer types
Fig. 4
Fig. 4
Overall survival and progression-free survival across cancer types
See this image and copyright information in PMC

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