Hiponatremia – Rokowania, prognozy i postęp choroby

Hiponatremia
Rokowania, prognozy i postęp choroby

Hiponatremia jest najczęstszym zaburzeniem elektrolitowym u pacjentów hospitalizowanych i stanowi niezależny czynnik prognostyczny w wielu schorzeniach, w tym COVID-19, zatorowości płucnej, ostrym zespole wieńcowym (ACS), chorobach nowotworowych, marskości wątroby oraz przewlekłej chorobie nerek. W COVID-19 hiponatremia wiąże się z istotnie gorszym rokowaniem (OR 2,65; p < 0,001), a w zatorowości płucnej zwiększa śmiertelność do 12,8% i 40,4% w przypadku hiponatremii nabytej i przetrwałej (vs. 2% przy normonatremii). W ACS hiponatremia podnosi ryzyko śmiertelności 30-dniowej (RR 2,18) oraz niewydolności serca (RR 1,71). W onkologii hiponatremia dotyczy niemal połowy pacjentów i jest silnym negatywnym czynnikiem prognostycznym, zwiększając ryzyko zgonu nawet trzykrotnie, szczególnie u chorych z przerzutami. W marskości wątroby i ACLF hiponatremia obniża przeżycie trzymiesięczne (35,8% vs 58,7%, p < 0,001). Hiponatremia jest także powiązana ze zwiększonym ryzykiem ostrego uszkodzenia nerek (AKI) oraz wyższą śmiertelnością u pacjentów dializowanych.

Prognoza w hiponatremii

Hiponatremia jako marker złego rokowania
Hiponatremia w chorobach nowotworowych
Hiponatremia w chorobach wątroby
Czynniki wpływające na rokowanie w hiponatremii
Wpływ korekcji hiponatremii na rokowanie
Hiponatremia i uszkodzenie nerek
Czynniki szczególne wpływające na śmiertelność w hiponatremii
Wnioski końcowe
Kolejne rozdziały

Prognoza w hiponatremii

Hiponatremia jest najczęstszym zaburzeniem elektrolitowym występującym u pacjentów hospitalizowanych i wiąże się z istotnym zwiększeniem ryzyka niekorzystnych wyników leczenia i śmiertelności ¹². Liczne badania wykazały, że hiponatremia stanowi niezależny czynnik prognostyczny w różnych scenariuszach klinicznych, a odpowiednie postępowanie terapeutyczne może mieć znaczący wpływ na rokowanie pacjentów ³⁴.

Hiponatremia jako marker złego rokowania

Hiponatremia wykazuje silny związek z niekorzystnym rokowaniem w wielu stanach chorobowych. W metaanalizie dotyczącej COVID-19 wykazano, że hiponatremia wiąże się z gorszym rokowaniem (OR 2,65 [1,89, 3,72], p < 0,001) z czułością 0,37 [0,27, 0,48] i swoistością 0,82 [0,72, 0,88] ⁵. Wysoka swoistość przy niskiej czułości wskazuje, że hiponatremia może być przydatna do potwierdzenia złego rokowania, ale nie do jego wykluczenia ⁶.

W przypadku zatorowości płucnej pacjenci z hiponatremią (zarówno nabytą, jak i przetrwałą) mieli znacząco wyższy wskaźnik śmiertelności w porównaniu z pacjentami z prawidłowym stężeniem sodu (12,8% i 40,4% vs. 2%, p < 0,001) ⁷. Średni czas przeżycia zmniejszał się z 23,624 miesięcy w grupie z normonatremią do 16,426 miesięcy w grupie z przetrwałą hiponatremią ⁸. Hiponatremia zwiększała ogólne ryzyko śmiertelności 11,855-krotnie w porównaniu z pacjentami z prawidłowym poziomem sodu ⁹.

W przypadku pacjentów z ostrym zespołem wieńcowym (ACS) metaanaliza 20 badań kohortowych obejmujących 34 782 pacjentów wykazała, że hiponatremia jest istotnie związana ze zwiększonym ryzykiem śmiertelności z wszystkich przyczyn w ciągu 30 dni (RR: 2,18; 95% CI: 1,96-2,42) oraz w okresie obserwacji (HR: 1,74; 95% CI: 1,56-1,94) ¹⁰. Hiponatremia okazała się również predyktorem niewydolności serca u pacjentów z ACS (RR: 1,71; 95% CI: 1,41-2,07) ¹¹.

Hiponatremia w chorobach nowotworowych

W populacji onkologicznej częstość występowania przewlekłej hiponatremii jest jeszcze wyższa niż u pacjentów hospitalizowanych z wszystkich przyczyn i dotyczy prawie połowy pacjentów z chorobą nowotworową ¹². Hiponatremia została zgłoszona jako niezależny, negatywny czynnik prognostyczny w różnych guzach litych i nowotworach krwi, takich jak niedrobnokomórkowy i drobnokomórkowy rak płuc, nowotwory przewodu pokarmowego, chłoniaki, rak wątrobowokomórkowy, rak nerkowokomórkowy, rak prostaty i trzustki, rak dróg żółciowych, międzybłoniak, wieloregionalny rak dróg moczowych górnego odcinka oraz nabłonkowy rak jajnika ¹³.

Obniżone stężenie sodu w surowicy ma wpływ na przeżycie na wszystkich etapach choroby nowotworowej, przy czym najwyższy wskaźnik śmiertelności wewnątrzszpitalnej występuje u pacjentów z przerzutami, a współczynnik ryzyka zgonu jest prawie trzykrotnie wyższy niż u chorych onkologicznych z normonatremią ¹⁴. W analizie wieloczynnikowej, hiponatremia przy przyjęciu, ciężkość hiponatremii oraz stadium choroby okazały się niezależnymi czynnikami prognostycznymi ¹⁵.

Występowanie hiponatremii przy przyjęciu lub podczas hospitalizacji może stanowić istotny czynnik wpływający na wynik leczenia i długość hospitalizacji ¹⁶. Ryzyko śmiertelności w ciągu 90 dni było wyższe we wszystkich grupach z hiponatremią w porównaniu z pacjentami z normonatremią (HR dla łagodnej, umiarkowanej i ciężkiej hiponatremii: 2,04; 4,74; i 3,46, odpowiednio) ¹⁷.

Hiponatremia w chorobach wątroby

U pacjentów z marskością wątroby i ostrą niewydolnością wątroby na tle przewlekłej choroby wątroby (ACLF), hiponatremia stanowi niezależny czynnik predykcyjny przeżycia ¹⁸. Obecność hiponatremii była związana ze zwiększoną śmiertelnością trzymiesięczną ¹⁹. Pacjenci z ACLF plus hiponatremią mieli bardzo niskie trzymiesięczne oczekiwane przeżycie w porównaniu z pacjentami z ACLF bez hiponatremii (35,8% vs 58,7%, odpowiednio; p < 0,001) ²⁰.

Czynniki wpływające na rokowanie w hiponatremii

Śmiertelność w ciężkiej hiponatremii wydaje się głównie wynikać z chorób współistniejących, choć są one potęgowane przez samą hiponatremię i jej leczenie, zwiększając tym samym ryzyko zgonu ²¹²². Prawie dwie trzecie pacjentów umiera z prawidłowym stężeniem sodu w osoczu, co wskazuje, że pacjenci są bardziej narażeni na śmierć z powodu przyczyny hiponatremii i/lub chorób współistniejących niż z powodu samej hiponatremii ²³.

W jednoczynnikowej analizie Coxa śmiertelność była istotnie i pozytywnie związana z płcią żeńską, wystąpieniem ciężkiej hiponatremii podczas hospitalizacji, utrzymywaniem się hiponatremii, brakiem rozpoznania, liczbą potencjalnych przyczyn, brakiem specyficznego leczenia hiponatremii, wskaźnikiem Charlsona i hipoalbuminemią. Odwodnienie było natomiast związane z lepszym rokowaniem ²⁴²⁵.

W analizie wieloczynnikowej przeżycie pozostało związane z normalizacją stężenia sodu w osoczu i parametrami związanymi z chorobami współistniejącymi, wskaźnikiem Charlsona i stężeniem albuminy w surowicy ²⁶²⁷.

Wpływ korekcji hiponatremii na rokowanie

Brak normalizacji stężenia sodu w osoczu zwiększa ryzyko zgonu ²⁸²⁹. Kluczową rolę odgrywa postępowanie kliniczne, co podkreśla fakt, że brak wstępnej analizy moczu, a także brak zarówno rozpoznania etiologicznego, jak i normalizacji stężenia sodu w osoczu były związane ze zwiększoną śmiertelnością ³⁰.

Metaanaliza 15 badań obejmujących 13 816 pacjentów wykazała, że jakakolwiek poprawa hiponatremii była związana ze zmniejszonym ryzykiem ogólnej śmiertelności (iloraz szans [OR] = 0,57). W ośmiu badaniach, które zgłosiły próg poprawy stężenia sodu w surowicy do 130 mmol/L, związek był jeszcze silniejszy (OR = 0,51). Zmniejszenie ryzyka śmiertelności utrzymywało się podczas 12-miesięcznej obserwacji (OR = 0,55). Zmniejszona śmiertelność była bardziej widoczna u starszych pacjentów i pacjentów z niższym stężeniem sodu w surowicy przy włączeniu do badania ³¹.

Dane sugerują, że korekta hiponatremii ma korzystny wpływ na wynik leczenia pacjentów z chorobą nowotworową ³². Istnieją silne dowody na to, że hiponatremia odgrywa ważną rolę w wpływaniu na wynik leczenia pacjentów z chorobą nowotworową i że nie można jej zaniedbywać. Hiponatremię należy szybko rozpoznać i skorygować, ponieważ normalizacja stężenia sodu w surowicy ma niezależny korzystny wpływ na rokowanie pacjentów z chorobą nowotworową ³³.

Hiponatremia i uszkodzenie nerek

Zaburzenia stężenia sodu (dysnatremia), w tym hiponatremia, wiążą się ze zwiększonym ryzykiem rozwoju ostrego uszkodzenia nerek (AKI) ³⁴. Większe wahania stężenia sodu były liniowo związane ze zwiększonym ryzykiem AKI niezależnie od szczytowej wartości sodu ³⁵. Badania wykazują silny i niezależny związek między zaburzeniami stężenia sodu i zmiennością sodu a ryzykiem rozwoju AKI ³⁶.

U pacjentów ze schyłkową niewydolnością nerek poddawanych hemodializie lub dializie otrzewnowej dowody sugerują, że ryzyko zgonu wzrasta wraz z incrementalnie niższymi poziomami sodu ³⁷. Przyczyny śmiertelności związanej z hiponatremią w populacji dializacyjnej pozostają niepewne, ale możliwości obejmują toksyczność ośrodkowego układu nerwowego, upadki i złamania, powikłania związane z infekcjami oraz upośledzoną funkcję serca ³⁸.

Czynniki szczególne wpływające na śmiertelność w hiponatremii

W badaniu pacjentów z ciężką hiponatremią wskaźnik śmiertelności wewnątrzszpitalnej wynosił 12,4%. Czynniki istotnie związane z śmiertelnością wewnątrzszpitalną obejmowały przewlekłą chorobę nerek i nowotwór, niedostateczną korektę stężenia sodu oraz obecność ciężkich objawów ³⁹. Ciężka hiponatremia u hospitalizowanych pacjentów wiąże się ze znaczną śmiertelnością. Częstość występowania nieoptymalnej korekty stężenia sodu jest wysoka; niedostateczna korekta, obecność ciężkich objawów, przewlekła choroba nerek i nowotwór były czynnikami, które zwiększają wskaźnik śmiertelności ⁴⁰.

Wnioski końcowe

Hiponatremia stanowi niezależny marker złego rokowania w różnych stanach klinicznych, w tym w chorobach nowotworowych, sercowo-naczyniowych, nerkowych i wątrobowych. Wyniki badań jednoznacznie wskazują, że obecność hiponatremii zwiększa ryzyko zgonu, przedłuża hospitalizację i pogarsza jakość życia pacjentów. Skuteczna korekta hiponatremii może poprawić rokowanie, choć wpływ na śmiertelność zależy również od chorób współistniejących i właściwego postępowania medycznego ⁴¹⁴².

Dokładne monitorowanie stężenia sodu, wczesne rozpoznanie hiponatremii, identyfikacja przyczyny oraz odpowiednie leczenie mają kluczowe znaczenie dla poprawy rokowania. Poprawa rokowania tych pacjentów może polegać na starannym leczeniu wszystkich współistniejących chorób, w tym na poprawie szkolenia personelu medycznego zajmującego się pacjentami z hiponatremią ⁴³.

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Materiały źródłowe

#1 Hyponatremia and Cancer: From Bedside to Benchside
https://www.mdpi.com/2072-6694/15/4/1197
Hyponatremia is the most common electrolyte disorder encountered in hospitalized patients. This applies also to cancer patients. […] There is evidence that hyponatremia is associated to a more negative outcome in several pathologies, including cancer. Many studies have demonstrated that in different cancer types, both progression-free survival and overall survival are negatively affected by hyponatremia, whereas the correction of serum [Na+] has a positive effect on patient outcome. […] Notably, hyponatremia has been associated to a significantly decreased progression-free and overall survival in these patients and serum [Na+] has been proposed as a possible biomarker to identify high-risk cancer patients. […] In the oncology setting, the prevalence of chronic hyponatremia is even higher than in patients hospitalized for all causes and it affects nearly half of cancer patients.
#2 Prognostic and predictive role of hyponatremia in cancer patients
https://www.oaepublish.com/articles/2394-4722.2019.14
Hyponatremia is the most frequent electrolyte disorder encountered in hospitalized patients. Several studies have demonstrated that hyponatremia is a negative prognostic factor in different clinical scenarios. Noteworthy, not only severe and acute hyponatremia has been associated with an increased risk of mortality, but also moderate of even mild chronic hyponatremia may increase the risk of death. This has been demonstrated in different categories of patients, including cancer patients. There is growing evidence that both progression free survival and overall survival are significantly reduced in cancer patients with hyponatremia compared to patients with normonatremia. […] The literature addressing cancer patients indicated that hyponatremia is a negative prognostic factor also in this subset of patients.
#3 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
https://pmc.ncbi.nlm.nih.gov/articles/PMC5075397/
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. 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. 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. Severe hyponatraemia is a serious condition associated with a very high mortality rate. Nearly two thirds of patients died with normal plasma sodium indicating that patients are more prone to die from the cause of hyponatraemia and/or comorbidities than from hyponatraemia per se. However the absence of normalisation in plasma sodium also increases the risk of death. Clinical management plays a crucial role as highlighted by the fact that lack of initial urine analysis as well as absence of both aetiological diagnosis and normalisation of plasma sodium were each associated with increased mortality.
#4 Prognostic and predictive role of hyponatremia in cancer patients
https://www.oaepublish.com/articles/2394-4722.2019.14
Hyponatremia is the most frequent electrolyte disorder encountered in hospitalized patients. Several studies have demonstrated that hyponatremia is a negative prognostic factor in different clinical scenarios. Noteworthy, not only severe and acute hyponatremia has been associated with an increased risk of mortality, but also moderate of even mild chronic hyponatremia may increase the risk of death. This has been demonstrated in different categories of patients, including cancer patients. There is growing evidence that both progression free survival and overall survival are significantly reduced in cancer patients with hyponatremia compared to patients with normonatremia. […] The literature addressing cancer patients indicated that hyponatremia is a negative prognostic factor also in this subset of patients.
#5 The Prognostic Value of Hyponatremia for Predicting Poor Outcome in Patients With COVID-19: A Systematic Review and Meta-Analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8236602/
Background: This meta-analysis aimed to assess the prognostic value of hyponatremia in patients with COVID-19. […] Hyponatremia was associated with poor outcome in COVID-19 (OR 2.65 [1.89, 3.72], p 0.001; I2: 67.2%). […] Hyponatremia has a sensitivity of 0.37 [0.27, 0.48], specificity of 0.82 [0.72, 0.88], PLR of 2.0 [1.5, 2.7], NLR of 0.77 [0.69, 0.87], DOR of 3 [2, 4], and AUC of 0.62 [0.58, 0.66] for predicting poor outcome. […] Hyponatremia was associated with poor outcome in patients with COVID-19. […] Hyponatremia indicates a higher risk for poor outcome in patients with COVID-19; however, due to low sensitivity but high specificity, it can be used to rule in, but not rule out, poor prognosis. […] Although this meta-analysis showed the association between hyponatremia and poor outcome in COVID-19, it did not necessarily equal to causality. […] In conclusion, hyponatremia was associated with poor outcome in patients with COVID-19.
#6 The Prognostic Value of Hyponatremia for Predicting Poor Outcome in Patients With COVID-19: A Systematic Review and Meta-Analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8236602/
Background: This meta-analysis aimed to assess the prognostic value of hyponatremia in patients with COVID-19. […] Hyponatremia was associated with poor outcome in COVID-19 (OR 2.65 [1.89, 3.72], p 0.001; I2: 67.2%). […] Hyponatremia has a sensitivity of 0.37 [0.27, 0.48], specificity of 0.82 [0.72, 0.88], PLR of 2.0 [1.5, 2.7], NLR of 0.77 [0.69, 0.87], DOR of 3 [2, 4], and AUC of 0.62 [0.58, 0.66] for predicting poor outcome. […] Hyponatremia was associated with poor outcome in patients with COVID-19. […] Hyponatremia indicates a higher risk for poor outcome in patients with COVID-19; however, due to low sensitivity but high specificity, it can be used to rule in, but not rule out, poor prognosis. […] Although this meta-analysis showed the association between hyponatremia and poor outcome in COVID-19, it did not necessarily equal to causality. […] In conclusion, hyponatremia was associated with poor outcome in patients with COVID-19.
#7 HyponatremiaâLong-Term Prognostic Factor for Nonfatal Pulmonary Embolism
https://www.mdpi.com/2075-4418/11/2/214
Hyponatremia is a negative prognostic factor. […] Patients with acquired and persistent hyponatremia had a significantly higher rate of mortality rate than those in the normonatremia group (12.8% and 40.4%, OR- 7.206, CI: 2.383â21.791, p = 0.000 and OR-33.250, CI: 11.521â95.960, p = 0.000 vs. 2%, p < 0.001, respectively). [...] The mean survival time decreases from 23.624 months (95% CI: (23.295â23.953)) in the normonatremia group to 16.426 months (95% CI: (13.17â19.134)) in the persistent hyponatremia group, statistically significant (p = 0.000). [...] In our study, the highest 6-month mortality rate was 29.8% and was recorded in group 4 compared to 35.7% in Ngâs study. [...] In the patients with hyponatremia and PE, there was an 11.855-fold increase in overall mortality risk compared to patients with normal sodium levels.
#8 HyponatremiaâLong-Term Prognostic Factor for Nonfatal Pulmonary Embolism
https://www.mdpi.com/2075-4418/11/2/214
Hyponatremia is a negative prognostic factor. […] Patients with acquired and persistent hyponatremia had a significantly higher rate of mortality rate than those in the normonatremia group (12.8% and 40.4%, OR- 7.206, CI: 2.383â21.791, p = 0.000 and OR-33.250, CI: 11.521â95.960, p = 0.000 vs. 2%, p < 0.001, respectively). [...] The mean survival time decreases from 23.624 months (95% CI: (23.295â23.953)) in the normonatremia group to 16.426 months (95% CI: (13.17â19.134)) in the persistent hyponatremia group, statistically significant (p = 0.000). [...] In our study, the highest 6-month mortality rate was 29.8% and was recorded in group 4 compared to 35.7% in Ngâs study. [...] In the patients with hyponatremia and PE, there was an 11.855-fold increase in overall mortality risk compared to patients with normal sodium levels.
#9 HyponatremiaâLong-Term Prognostic Factor for Nonfatal Pulmonary Embolism
https://www.mdpi.com/2075-4418/11/2/214
Hyponatremia is a negative prognostic factor. […] Patients with acquired and persistent hyponatremia had a significantly higher rate of mortality rate than those in the normonatremia group (12.8% and 40.4%, OR- 7.206, CI: 2.383â21.791, p = 0.000 and OR-33.250, CI: 11.521â95.960, p = 0.000 vs. 2%, p < 0.001, respectively). [...] The mean survival time decreases from 23.624 months (95% CI: (23.295â23.953)) in the normonatremia group to 16.426 months (95% CI: (13.17â19.134)) in the persistent hyponatremia group, statistically significant (p = 0.000). [...] In our study, the highest 6-month mortality rate was 29.8% and was recorded in group 4 compared to 35.7% in Ngâs study. [...] In the patients with hyponatremia and PE, there was an 11.855-fold increase in overall mortality risk compared to patients with normal sodium levels.
#10 Short- and long-term prognostic value of hyponatremia in patients with acute coronary syndrome: A systematic review and meta-analysis | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193857
Hyponatremia is relevant to heart failure, liver cirrhosis and stroke, but the prognostic value of serum sodium levels in patients with acute coronary syndrome are still unclear. […] Compared with the normal natrium, hyponatremia was significantly associated with the increased risks of all-cause mortality within 30 days (RR: 2.18; 95%CI: 1.96-2.42) and during the follow-ups (HR: 1.74; 95%CI: 1.56-1.94). […] In conclusion, hyponatremia has a significant prognostic value for short- and long-term adverse event in patients after ACS, the dynamic monitoring of serum sodium levels may could help physicians to identify high risk ACS patients and to stratify risk for optimal management. […] Our meta-analysis of 20 cohort studies including 34,782 patients, which further investigated the prognostic value of hyponatremia in ACS patients, showed that hyponatremia is significantly associated with the increased risk of all-cause mortality within 30 days (RR: 2.18; 95%CI: 1.96-2.42) and during the following-ups (HR: 1.74; 95%CI: 1.56-1.94).
#11 Short- and long-term prognostic value of hyponatremia in patients with acute coronary syndrome: A systematic review and meta-analysis | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193857
Hyponatremia is a predictor of heart failure in patients with ACS (RR: 1.71; 95%CI: 1.41-2.07), the potential mechanism may be similar to the influence of hyponatremia on prognosis in patients with congestive heart failureâthe release of vasopressin, activation of the renin-angiotensin system and catecholamine production.
#12 Hyponatremia and Cancer: From Bedside to Benchside
https://www.mdpi.com/2072-6694/15/4/1197
Hyponatremia is the most common electrolyte disorder encountered in hospitalized patients. This applies also to cancer patients. […] There is evidence that hyponatremia is associated to a more negative outcome in several pathologies, including cancer. Many studies have demonstrated that in different cancer types, both progression-free survival and overall survival are negatively affected by hyponatremia, whereas the correction of serum [Na+] has a positive effect on patient outcome. […] Notably, hyponatremia has been associated to a significantly decreased progression-free and overall survival in these patients and serum [Na+] has been proposed as a possible biomarker to identify high-risk cancer patients. […] In the oncology setting, the prevalence of chronic hyponatremia is even higher than in patients hospitalized for all causes and it affects nearly half of cancer patients.
#13 Hyponatremia and Cancer: From Bedside to Benchside
https://www.mdpi.com/2072-6694/15/4/1197
Hyponatremia was reported as an independent, negative prognostic factor in different solid and blood tumours, such as NSCLC, and SCLC, gastrointestinal cancers, lymphoma, hepatocellular carcinoma, renal cell carcinoma, prostatic and pancreatic carcinoma, biliary tract cancer, mesothelioma, multiregional upper tract urothelial carcinoma, and epithelial ovarian cancer. […] Reduced serum [Na+] has an impact on survival at all cancer stages, with the highest rate of in-hospital mortality in metastatic patients and a hazard ratio for death almost three fold higher than in normonatremic oncologic subjects. […] These data may suggest that the correction of hyponatremia has a favourable role in the outcome of cancer patients. […] Based on these data, hyponatremia has been proposed as a reliable biomarker of high-risk subjects with lung cancer.
#14 Hyponatremia and Cancer: From Bedside to Benchside
https://www.mdpi.com/2072-6694/15/4/1197
Hyponatremia was reported as an independent, negative prognostic factor in different solid and blood tumours, such as NSCLC, and SCLC, gastrointestinal cancers, lymphoma, hepatocellular carcinoma, renal cell carcinoma, prostatic and pancreatic carcinoma, biliary tract cancer, mesothelioma, multiregional upper tract urothelial carcinoma, and epithelial ovarian cancer. […] Reduced serum [Na+] has an impact on survival at all cancer stages, with the highest rate of in-hospital mortality in metastatic patients and a hazard ratio for death almost three fold higher than in normonatremic oncologic subjects. […] These data may suggest that the correction of hyponatremia has a favourable role in the outcome of cancer patients. […] Based on these data, hyponatremia has been proposed as a reliable biomarker of high-risk subjects with lung cancer.
#15
https://link.springer.com/article/10.1007/s00520-015-2683-z
Hyponatremia is the most common electrolyte disorder in hospitalized patients, and it might be an indicator of poor prognosis and might have negative effects on hospitalization length and quality of life in non-malignant as well as in malignant diseases. […] A significant difference in overall survival since the date of admission was observed between eunatremic and hyponatremic patients (p=0.0255). […] At multivariate analysis, hyponatremia at admission, severity of hyponatremia, and stage of disease resulted independent prognostic factors. […] The occurrence of hyponatremia at the admission or during the hospitalization may represent a significant factor influencing the outcome and the length of hospitalization.
#16
https://link.springer.com/article/10.1007/s00520-015-2683-z
Hyponatremia is the most common electrolyte disorder in hospitalized patients, and it might be an indicator of poor prognosis and might have negative effects on hospitalization length and quality of life in non-malignant as well as in malignant diseases. […] A significant difference in overall survival since the date of admission was observed between eunatremic and hyponatremic patients (p=0.0255). […] At multivariate analysis, hyponatremia at admission, severity of hyponatremia, and stage of disease resulted independent prognostic factors. […] The occurrence of hyponatremia at the admission or during the hospitalization may represent a significant factor influencing the outcome and the length of hospitalization.
#17 Prognostic and predictive role of hyponatremia in cancer patients
https://www.oaepublish.com/articles/2394-4722.2019.14
Hyponatremia was one of the multiple predictors of a negative outcome (HR 3.02, 95%CI: 1.76-5.17, P 0.001), together with younger age, hypernatremia, high blood urea nitrogen, high heart rate, high respiration rate, and supplemental oxygen use. […] In all hyponatremic groups the risk of mortality at 90 days was higher than in normonatremic patients (HR for mild, moderate, and severe hyponatremia: 2.04 (95%CI: 1.42-2.91; P0.01); 4.74 (95%CI: 3.21-7.01;P0.01), and 3.46 (95%CI: 1.05-11.44;P = 0.04), respectively. […] Hyponatremic patients had a significantly reduced OS (P = 0.0255) compared to normonatremic patients. […] Hyponatremia was negatively associated with OS in all types of tumor, but the highest HRs were found in lymphoma (HR 4.5, P0.01) and in breast cancer (HR 3.7,P 0.1). […] The authors found that patients with malignancy-associated SIAD had a significantly shorter median survival (58 days vs. 910 days,P 0.001).
#18 Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0700-0
Hyponatremia is a marker of poor prognosis in patients with cirrhosis. This analysis aimed to assess if hyponatremia also has prognostic value in patients with acute-on-chronic liver failure (ACLF), a syndrome characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality. […] The presence of hyponatremia (at inclusion or during hospitalization) was a predictive factor of survival both in patients with and without ACLF. […] The presence of hyponatremia is an independent predictive factor of survival in patients with ACLF. In cirrhosis, outcome of patients with ACLF is dependent on its association with hyponatremia. […] The presence of hyponatremia was associated with increased three-month mortality. […] Patients with ACLF plus hyponatremia had very low three-month survival expectancy compared to that of patients with ACLF without hyponatremia (35.8% vs. 58.7%, respectively; P0.001). […] Mortality rates are clearly different among patients with ACLF with and without hyponatremia. In patients with ACLF prognosis is clearly dependent on its association with hyponatremia.
#19 Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0700-0
Hyponatremia is a marker of poor prognosis in patients with cirrhosis. This analysis aimed to assess if hyponatremia also has prognostic value in patients with acute-on-chronic liver failure (ACLF), a syndrome characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality. […] The presence of hyponatremia (at inclusion or during hospitalization) was a predictive factor of survival both in patients with and without ACLF. […] The presence of hyponatremia is an independent predictive factor of survival in patients with ACLF. In cirrhosis, outcome of patients with ACLF is dependent on its association with hyponatremia. […] The presence of hyponatremia was associated with increased three-month mortality. […] Patients with ACLF plus hyponatremia had very low three-month survival expectancy compared to that of patients with ACLF without hyponatremia (35.8% vs. 58.7%, respectively; P0.001). […] Mortality rates are clearly different among patients with ACLF with and without hyponatremia. In patients with ACLF prognosis is clearly dependent on its association with hyponatremia.
#20 Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0700-0
Hyponatremia is a marker of poor prognosis in patients with cirrhosis. This analysis aimed to assess if hyponatremia also has prognostic value in patients with acute-on-chronic liver failure (ACLF), a syndrome characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality. […] The presence of hyponatremia (at inclusion or during hospitalization) was a predictive factor of survival both in patients with and without ACLF. […] The presence of hyponatremia is an independent predictive factor of survival in patients with ACLF. In cirrhosis, outcome of patients with ACLF is dependent on its association with hyponatremia. […] The presence of hyponatremia was associated with increased three-month mortality. […] Patients with ACLF plus hyponatremia had very low three-month survival expectancy compared to that of patients with ACLF without hyponatremia (35.8% vs. 58.7%, respectively; P0.001). […] Mortality rates are clearly different among patients with ACLF with and without hyponatremia. In patients with ACLF prognosis is clearly dependent on its association with hyponatremia.
#21 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
https://pmc.ncbi.nlm.nih.gov/articles/PMC5075397/
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. 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. 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. Severe hyponatraemia is a serious condition associated with a very high mortality rate. Nearly two thirds of patients died with normal plasma sodium indicating that patients are more prone to die from the cause of hyponatraemia and/or comorbidities than from hyponatraemia per se. However the absence of normalisation in plasma sodium also increases the risk of death. Clinical management plays a crucial role as highlighted by the fact that lack of initial urine analysis as well as absence of both aetiological diagnosis and normalisation of plasma sodium were each associated with increased mortality.
#22 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 | BMC Nephrology | Full Text
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0370-z
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. The present study aimed to analyse the relationship between comorbidity, medical management and prognosis in severe hyponatraemic patients. 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. The high mortality rate associated with severe hyponatraemia suggests a causal relationship. However, the relationship between the magnitude of hyponatraemia and mortality remains a matter of debate and the disease causing hyponatraemia may be more responsible for the observed mortality than hyponatraemia per se. In multivariate Cox analysis, mortality was significantly associated with plasma sodium normalisation, urine analysis, Charlson Comorbidity Index and serum albumin. In univariate Cox analysis, mortality was significantly and positively associated with female gender, onset of severe hyponatraemia during hospitalisation, persistence of hyponatraemia, absence of diagnosis, number of potential causes, lack of specific treatment for hyponatraemia, Charlson index and hypoalbuminaemia. Conversely, dehydration was associated with better prognosis. In multivariate analysis, survival remained associated with the normalisation of plasma sodium and parameters associated with comorbidities, Charlson index and serum albumin. The absence of normalisation in plasma sodium also increases the risk of death. Improving the prognosis of these patients may rely on a careful management of all associated comorbidities, including improving the training of medical personnel involved in the care of hyponatraemic patients.
#23 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
https://pmc.ncbi.nlm.nih.gov/articles/PMC5075397/
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. 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. 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. Severe hyponatraemia is a serious condition associated with a very high mortality rate. Nearly two thirds of patients died with normal plasma sodium indicating that patients are more prone to die from the cause of hyponatraemia and/or comorbidities than from hyponatraemia per se. However the absence of normalisation in plasma sodium also increases the risk of death. Clinical management plays a crucial role as highlighted by the fact that lack of initial urine analysis as well as absence of both aetiological diagnosis and normalisation of plasma sodium were each associated with increased mortality.
#24 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
https://pmc.ncbi.nlm.nih.gov/articles/PMC5075397/
In univariate Cox analysis, mortality was significantly and positively associated with female gender, onset of severe hyponatraemia during hospitalisation, persistence of hyponatraemia, absence of diagnosis, number of potential causes, lack of specific treatment for hyponatraemia, Charlson index and hypoalbuminaemia. Conversely, dehydration was associated with better prognosis. […] In multivariate analysis, survival remained associated with the normalisation of plasma sodium and parameters associated with comorbidities, Charlson index and serum albumin.
#25 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 | BMC Nephrology | Full Text
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0370-z
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. The present study aimed to analyse the relationship between comorbidity, medical management and prognosis in severe hyponatraemic patients. 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. The high mortality rate associated with severe hyponatraemia suggests a causal relationship. However, the relationship between the magnitude of hyponatraemia and mortality remains a matter of debate and the disease causing hyponatraemia may be more responsible for the observed mortality than hyponatraemia per se. In multivariate Cox analysis, mortality was significantly associated with plasma sodium normalisation, urine analysis, Charlson Comorbidity Index and serum albumin. In univariate Cox analysis, mortality was significantly and positively associated with female gender, onset of severe hyponatraemia during hospitalisation, persistence of hyponatraemia, absence of diagnosis, number of potential causes, lack of specific treatment for hyponatraemia, Charlson index and hypoalbuminaemia. Conversely, dehydration was associated with better prognosis. In multivariate analysis, survival remained associated with the normalisation of plasma sodium and parameters associated with comorbidities, Charlson index and serum albumin. The absence of normalisation in plasma sodium also increases the risk of death. Improving the prognosis of these patients may rely on a careful management of all associated comorbidities, including improving the training of medical personnel involved in the care of hyponatraemic patients.
#26 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
https://pmc.ncbi.nlm.nih.gov/articles/PMC5075397/
In univariate Cox analysis, mortality was significantly and positively associated with female gender, onset of severe hyponatraemia during hospitalisation, persistence of hyponatraemia, absence of diagnosis, number of potential causes, lack of specific treatment for hyponatraemia, Charlson index and hypoalbuminaemia. Conversely, dehydration was associated with better prognosis. […] In multivariate analysis, survival remained associated with the normalisation of plasma sodium and parameters associated with comorbidities, Charlson index and serum albumin.
#27 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 | BMC Nephrology | Full Text
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0370-z
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. The present study aimed to analyse the relationship between comorbidity, medical management and prognosis in severe hyponatraemic patients. 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. The high mortality rate associated with severe hyponatraemia suggests a causal relationship. However, the relationship between the magnitude of hyponatraemia and mortality remains a matter of debate and the disease causing hyponatraemia may be more responsible for the observed mortality than hyponatraemia per se. In multivariate Cox analysis, mortality was significantly associated with plasma sodium normalisation, urine analysis, Charlson Comorbidity Index and serum albumin. In univariate Cox analysis, mortality was significantly and positively associated with female gender, onset of severe hyponatraemia during hospitalisation, persistence of hyponatraemia, absence of diagnosis, number of potential causes, lack of specific treatment for hyponatraemia, Charlson index and hypoalbuminaemia. Conversely, dehydration was associated with better prognosis. In multivariate analysis, survival remained associated with the normalisation of plasma sodium and parameters associated with comorbidities, Charlson index and serum albumin. The absence of normalisation in plasma sodium also increases the risk of death. Improving the prognosis of these patients may rely on a careful management of all associated comorbidities, including improving the training of medical personnel involved in the care of hyponatraemic patients.
#28 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
https://pmc.ncbi.nlm.nih.gov/articles/PMC5075397/
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. 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. 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. Severe hyponatraemia is a serious condition associated with a very high mortality rate. Nearly two thirds of patients died with normal plasma sodium indicating that patients are more prone to die from the cause of hyponatraemia and/or comorbidities than from hyponatraemia per se. However the absence of normalisation in plasma sodium also increases the risk of death. Clinical management plays a crucial role as highlighted by the fact that lack of initial urine analysis as well as absence of both aetiological diagnosis and normalisation of plasma sodium were each associated with increased mortality.
#29 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 | BMC Nephrology | Full Text
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0370-z
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. The present study aimed to analyse the relationship between comorbidity, medical management and prognosis in severe hyponatraemic patients. 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. The high mortality rate associated with severe hyponatraemia suggests a causal relationship. However, the relationship between the magnitude of hyponatraemia and mortality remains a matter of debate and the disease causing hyponatraemia may be more responsible for the observed mortality than hyponatraemia per se. In multivariate Cox analysis, mortality was significantly associated with plasma sodium normalisation, urine analysis, Charlson Comorbidity Index and serum albumin. In univariate Cox analysis, mortality was significantly and positively associated with female gender, onset of severe hyponatraemia during hospitalisation, persistence of hyponatraemia, absence of diagnosis, number of potential causes, lack of specific treatment for hyponatraemia, Charlson index and hypoalbuminaemia. Conversely, dehydration was associated with better prognosis. In multivariate analysis, survival remained associated with the normalisation of plasma sodium and parameters associated with comorbidities, Charlson index and serum albumin. The absence of normalisation in plasma sodium also increases the risk of death. Improving the prognosis of these patients may rely on a careful management of all associated comorbidities, including improving the training of medical personnel involved in the care of hyponatraemic patients.
#30 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
https://pmc.ncbi.nlm.nih.gov/articles/PMC5075397/
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. 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. 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. Severe hyponatraemia is a serious condition associated with a very high mortality rate. Nearly two thirds of patients died with normal plasma sodium indicating that patients are more prone to die from the cause of hyponatraemia and/or comorbidities than from hyponatraemia per se. However the absence of normalisation in plasma sodium also increases the risk of death. Clinical management plays a crucial role as highlighted by the fact that lack of initial urine analysis as well as absence of both aetiological diagnosis and normalisation of plasma sodium were each associated with increased mortality.
#31 Hyponatremia: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/242166-overview
The prognosis for patients with hyponatremia is predicated upon the underlying etiology. Hyponatremia in patients with cancer is associated with extended hospital stays and higher mortality rates; however, whether long-term correction of hyponatremia would improve these outcomes is unclear. […] In patients with end-stage renal disease who are receiving hemodialysis or peritoneal dialysis, evidence suggests that the risk of death rises with incrementally lower sodium levels. Causes of hyponatremia-related mortality in the dialysis population remain uncertain, but possibilities include central nervous system toxicity, falls and fractures, infection-related complications, and impaired cardiac function. […] A meta-analysis of 15 studies encompassing 13,816 patients found that any improvement in hyponatremia was associated with a reduced risk of overall mortality (odds ratio [OR]=0.57). With the eight studies that reported a threshold for serum sodium improvement to 130 mmol/L, the association was even stronger (OR=0.51). The reduction in mortality risk persisted at 12-month follow-up (OR=0.55). Reduced mortality was more evident in older patients and in patients with lower serum sodium levels at enrollment.
#32 Hyponatremia and Cancer: From Bedside to Benchside
https://www.mdpi.com/2072-6694/15/4/1197
Hyponatremia was reported as an independent, negative prognostic factor in different solid and blood tumours, such as NSCLC, and SCLC, gastrointestinal cancers, lymphoma, hepatocellular carcinoma, renal cell carcinoma, prostatic and pancreatic carcinoma, biliary tract cancer, mesothelioma, multiregional upper tract urothelial carcinoma, and epithelial ovarian cancer. […] Reduced serum [Na+] has an impact on survival at all cancer stages, with the highest rate of in-hospital mortality in metastatic patients and a hazard ratio for death almost three fold higher than in normonatremic oncologic subjects. […] These data may suggest that the correction of hyponatremia has a favourable role in the outcome of cancer patients. […] Based on these data, hyponatremia has been proposed as a reliable biomarker of high-risk subjects with lung cancer.
#33 Hyponatremia and Cancer: From Bedside to Benchside
https://www.mdpi.com/2072-6694/15/4/1197
There is strong evidence that hyponatremia has an important role in affecting patient outcome in cancer and that it cannot be neglected. In fact, hyponatremia should be promptly recognized and corrected, because the normalization of serum [Na+] has an independent beneficial effect on the prognosis of cancer patients.
#34
https://link.springer.com/article/10.1007/s11739-020-02462-5
A dysnatremic condition was associated with increased risk of AKI development. […] Dysnatremia, hyponatremia or hypernatremia are significantly associated with acute kidney injury and higher Na variability (CV) predicts AKI development during hospital stay. […] Higher Na fluctuations were linearly related to an increased risk of AKI independently of Na peak value. […] An independent relationship between Na disturbances and Na variability emerges from our study. […] Our study demonstrates a strong and independent association between Na disturbances and Na variability with the risk of AKI development. […] Dysnatremia is a common condition that involves AKI patients; and high Na variability might be considered a good biological marker that anticipates kidney injury development.
#35
https://link.springer.com/article/10.1007/s11739-020-02462-5
A dysnatremic condition was associated with increased risk of AKI development. […] Dysnatremia, hyponatremia or hypernatremia are significantly associated with acute kidney injury and higher Na variability (CV) predicts AKI development during hospital stay. […] Higher Na fluctuations were linearly related to an increased risk of AKI independently of Na peak value. […] An independent relationship between Na disturbances and Na variability emerges from our study. […] Our study demonstrates a strong and independent association between Na disturbances and Na variability with the risk of AKI development. […] Dysnatremia is a common condition that involves AKI patients; and high Na variability might be considered a good biological marker that anticipates kidney injury development.
#36
https://link.springer.com/article/10.1007/s11739-020-02462-5
A dysnatremic condition was associated with increased risk of AKI development. […] Dysnatremia, hyponatremia or hypernatremia are significantly associated with acute kidney injury and higher Na variability (CV) predicts AKI development during hospital stay. […] Higher Na fluctuations were linearly related to an increased risk of AKI independently of Na peak value. […] An independent relationship between Na disturbances and Na variability emerges from our study. […] Our study demonstrates a strong and independent association between Na disturbances and Na variability with the risk of AKI development. […] Dysnatremia is a common condition that involves AKI patients; and high Na variability might be considered a good biological marker that anticipates kidney injury development.
#37 Hyponatremia: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/242166-overview
The prognosis for patients with hyponatremia is predicated upon the underlying etiology. Hyponatremia in patients with cancer is associated with extended hospital stays and higher mortality rates; however, whether long-term correction of hyponatremia would improve these outcomes is unclear. […] In patients with end-stage renal disease who are receiving hemodialysis or peritoneal dialysis, evidence suggests that the risk of death rises with incrementally lower sodium levels. Causes of hyponatremia-related mortality in the dialysis population remain uncertain, but possibilities include central nervous system toxicity, falls and fractures, infection-related complications, and impaired cardiac function. […] A meta-analysis of 15 studies encompassing 13,816 patients found that any improvement in hyponatremia was associated with a reduced risk of overall mortality (odds ratio [OR]=0.57). With the eight studies that reported a threshold for serum sodium improvement to 130 mmol/L, the association was even stronger (OR=0.51). The reduction in mortality risk persisted at 12-month follow-up (OR=0.55). Reduced mortality was more evident in older patients and in patients with lower serum sodium levels at enrollment.
#38 Hyponatremia: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/242166-overview
The prognosis for patients with hyponatremia is predicated upon the underlying etiology. Hyponatremia in patients with cancer is associated with extended hospital stays and higher mortality rates; however, whether long-term correction of hyponatremia would improve these outcomes is unclear. […] In patients with end-stage renal disease who are receiving hemodialysis or peritoneal dialysis, evidence suggests that the risk of death rises with incrementally lower sodium levels. Causes of hyponatremia-related mortality in the dialysis population remain uncertain, but possibilities include central nervous system toxicity, falls and fractures, infection-related complications, and impaired cardiac function. […] A meta-analysis of 15 studies encompassing 13,816 patients found that any improvement in hyponatremia was associated with a reduced risk of overall mortality (odds ratio [OR]=0.57). With the eight studies that reported a threshold for serum sodium improvement to 130 mmol/L, the association was even stronger (OR=0.51). The reduction in mortality risk persisted at 12-month follow-up (OR=0.55). Reduced mortality was more evident in older patients and in patients with lower serum sodium levels at enrollment.
#39 Factors affecting prognosis of the patients with severe hyponatremia | NefrologÃa
https://www.revistanefrologia.com/es-factors-affecting-prognosis-patients-with-articulo-S0211699521001028
Hyponatremia is one of the most common electrolyte abnormalities in clinical practice. Data regarding factors that have impact on mortality of severe hyponatremia and outcomes of its therapeutic management is insufficient. The present study aimed to examine the factors associated with mortality and the outcomes of treatment in patients with severe hyponatremia. […] In-hospital mortality rate was 12.4% and having CKD and cancer, undercorrection of sodium and presence of severe symptoms were significantly associated with in-hospital mortality. […] Severe hyponatremia in hospitalized patients is associated with substantial mortality. The incidence of non-optimal correction of serum Na is high; under-correction, presence of severe symptoms, chronic kidney disease and cancer were the factors that increase mortality rate.
#40 Factors affecting prognosis of the patients with severe hyponatremia | NefrologÃa
https://www.revistanefrologia.com/es-factors-affecting-prognosis-patients-with-articulo-S0211699521001028
Hyponatremia is one of the most common electrolyte abnormalities in clinical practice. Data regarding factors that have impact on mortality of severe hyponatremia and outcomes of its therapeutic management is insufficient. The present study aimed to examine the factors associated with mortality and the outcomes of treatment in patients with severe hyponatremia. […] In-hospital mortality rate was 12.4% and having CKD and cancer, undercorrection of sodium and presence of severe symptoms were significantly associated with in-hospital mortality. […] Severe hyponatremia in hospitalized patients is associated with substantial mortality. The incidence of non-optimal correction of serum Na is high; under-correction, presence of severe symptoms, chronic kidney disease and cancer were the factors that increase mortality rate.
#41 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
https://pmc.ncbi.nlm.nih.gov/articles/PMC5075397/
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. 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. 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. Severe hyponatraemia is a serious condition associated with a very high mortality rate. Nearly two thirds of patients died with normal plasma sodium indicating that patients are more prone to die from the cause of hyponatraemia and/or comorbidities than from hyponatraemia per se. However the absence of normalisation in plasma sodium also increases the risk of death. Clinical management plays a crucial role as highlighted by the fact that lack of initial urine analysis as well as absence of both aetiological diagnosis and normalisation of plasma sodium were each associated with increased mortality.
#42 Prognostic and predictive role of hyponatremia in cancer patients
https://www.oaepublish.com/articles/2394-4722.2019.14
A correlation between hyponatremia and a negative outcome was found also in patients with terminal cancer. […] Clinical data clearly indicate that hyponatremia may be viewed as a predictor of a negative outcome in cancer patients. […] In recent years evidence indicating that hyponatremia is a predictor of a worse outcome in cancer patients has accumulated. There is emerging evidence, mainly from basic research studies at this time, that hyponatremia may by itself increase the risk of mortality of patients, rather than being a simple bystander of the progression of the disease. However, robust confirmatory data from clinical practice are certainly needed in order to definitively validate the hypothesis that cancer patients may die for hyponatremia.
#43 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 | BMC Nephrology | Full Text
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0370-z
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. The present study aimed to analyse the relationship between comorbidity, medical management and prognosis in severe hyponatraemic patients. 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. The high mortality rate associated with severe hyponatraemia suggests a causal relationship. However, the relationship between the magnitude of hyponatraemia and mortality remains a matter of debate and the disease causing hyponatraemia may be more responsible for the observed mortality than hyponatraemia per se. In multivariate Cox analysis, mortality was significantly associated with plasma sodium normalisation, urine analysis, Charlson Comorbidity Index and serum albumin. In univariate Cox analysis, mortality was significantly and positively associated with female gender, onset of severe hyponatraemia during hospitalisation, persistence of hyponatraemia, absence of diagnosis, number of potential causes, lack of specific treatment for hyponatraemia, Charlson index and hypoalbuminaemia. Conversely, dehydration was associated with better prognosis. In multivariate analysis, survival remained associated with the normalisation of plasma sodium and parameters associated with comorbidities, Charlson index and serum albumin. The absence of normalisation in plasma sodium also increases the risk of death. Improving the prognosis of these patients may rely on a careful management of all associated comorbidities, including improving the training of medical personnel involved in the care of hyponatraemic patients.