Prognosis of patients with severe hyponatraemia is related not only to hyponatraemia but also to comorbidities and to medical management: results of an observational retrospective study

Abstract

Background: The true cause of death in severe hyponatraemic patients remains controversial. The present study aimed to analyse the relationship between comorbidity, medical management and prognosis in severe hyponatraemic patients.

Methods: Medical records of all patients hospitalised in our institution in 2012 with a plasma sodium ≤120 mmol/l were retrospectively analysed.

Results: One hundred forty-seven of 64 723 adult patients (0.2 %) were identified with severe hyponatraemia. In-hospital mortality rate was 24.5 and 50.3 % after a median follow-up of 431 days. Patients with plasma sodium <110 mmol/l had less comorbidity (Charlson Comorbidity Index 2.2 ± 1.9 vs. 4.0 ± 3.1 (plasma sodium 110-115 mmol/l) and 4.2 ± 3.1 (plasma sodium 116-120 mmol/l); P = .02)) and a small trend for less mortality, respectively 40.0, 51.2 and 52.3 % (P = .64). At discharge, nonsurvivors and survivors had similar plasma sodium with 58.3 % of nonsurvivors being normonatraemic. Urine analysis was performed in 74.2 % of cases and associated with lower in-hospital mortality (20.2 % vs. 36.8 %, P = .05). In multivariate Cox analysis, mortality was significantly associated with plasma sodium normalisation (HR 0.35, P < 0.001), urine analysis (HR 0.48, P = .01), Charlson Comorbidity Index (HR 1.23, P < .001) and serum albumin (HR 0.88, P < .001).

Conclusion: Mortality in severe hyponatraemia appears mainly due to comorbidities although the latter are potentiated by hyponatraemia itself and its management thereby exacerbating the risk of death.

Keywords: Clinical decision-making; Hyponatraemia; Patient care management; Prognosis; Retrospective studies.

Fig. 1

Flow chart

Fig. 2

Relationship between plasma sodium and the Charlson comorbidity index. a scatterplot of the Charlson comorbidity index according to the nadir plasma sodium. b boxplot of the Charlson comorbidity index according to different groups of nadir plasma sodium, <110 mmol/l, 110 to 115 mmol/l and 116 to 120 mmol/l

Fig. 3

Patient survival curves. Survival according to: a the nadir of plasma sodium, b community-acquired vs. hospital-acquired hyponatraemia, c the Charlson comorbidity index, d serum albumin tertiles, e the absence vs. normalisation of plasma sodium and f the performing of urine analysis