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. 2017 Aug:40:63-68.
doi: 10.1016/j.jcrc.2017.02.012. Epub 2017 Feb 13.

The association between sodium fluctuations and mortality in surgical patients requiring intensive care

Dominic C Marshall  1 , Justin D Salciccioli  2 , Ross J Goodson  3 , Marco A Pimentel  4 , Kristi Y Sun  3 , Leo Anthony Celi  5 , Joseph Shalhoub  6
Affiliations

The association between sodium fluctuations and mortality in surgical patients requiring intensive care

Dominic C Marshall et al. J Crit Care. 2017 Aug.

Abstract

Purpose: Serum sodium derangement is the most common electrolyte disturbance among patients admitted to intensive care. This study aims to validate the association between dysnatremia and serum sodium fluctuation with mortality in surgical intensive care patients.

Method: We performed a retrospective analysis of the Medical Information Mart for Intensive Care II database. Dysnatremia was defined as a sodium concentration outside physiologic range (135-145mmol/L) and subjects were categorized by severity of dysnatremia and sodium fluctuation. Univariate and multivariable logistic regressions were used to test for associations between sodium fluctuations and mortality.

Results: We identified 8600 subjects, 39% of whom were female, with a median age of 66years for analysis. Subjects with dysnatremia were more likely to be dead at 28 days (17% vs 7%; P<.001). There was a significant association between sodium fluctuation and mortality at 28 days (adjusted odds ratio per 1mmol/L change, 1.10 [95% confidence interval, 1.08-1.12; P<.001]), even in patients who remained normotremic during their intensive care unit stay (1.12 [95% confidence interval, 1.09-1.16; P<.001]) CONCLUSIONS: This observational study validates previous findings of an association between serum sodium fluctuations and mortality in surgical intensive care patients. This association was also present in subjects who remained normonatremic throughout their intensive care unit admission.

Keywords: Dysnatremia; Electrolyte disturbances; Mortality; Sodium; Surgery.

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Conflict of interest statement

Conflict of interest: The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Schematic representation of the 28-day mortality of postoperative ICU patients according to serum sodium levels on ICU admission. χ2 Test for the difference between normotremic and dysnatremic patients.
Fig. 2
Fig. 2
Adjusted ORs of 28-day and 1-year mortality of patients with different severities of dysnatremia. An increased risk of both 28-day and 1-year mortality in patients with dysnatremia is shown when compared with reference patients with serum sodium levels of 135 to 145 mmol/L. When looking at 28-day and 1-year mortality, there is a stepwise increase in risk of mortality with increasing severity of serum sodium dysregulation.
Fig. 3
Fig. 3
Bar chart representing maximum serum sodium fluctuations (mmol/L) and mortality (%) in patients admitted to surgical ICU (P < .0001; Mantel-Haenszel test).
Fig. 4
Fig. 4
Bar chart representing maximum sodium fluctuations (mmol/L) and mortality (%) in patients who were normonatremic on admission to surgical ICU (P < .0001; Mantel-Haenszel test).
See this image and copyright information in PMC

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