Fluctuations in serum sodium levels linked to increased mortality risk
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The trajectories of serum sodium levels in hospitalized patients may help predict in-hospital mortality and mortality risk at 1 year, with the highest risk of death found when serum sodium fluctuated “considerably,” according to this study.
“Although single serum sodium levels have been shown to be associated with patient outcomes, its variations or direction of changes could also provide additional information regarding outcomes of patients who are hospitalized,” Api Chewcharat, MD, of the Mayo Clinic in Rochester, and colleagues wrote. “It is known that the rapid rate of serum sodium disturbances and their correction could lead to neurologic sequelae, but there is no evidence regarding the relationship.”
Hypothesizing that different serum sodium trajectories among hospitalized patients would be associated with varying outcomes, the researchers included 43,539 patients who were hospitalized between 2011 and 2013.
Trends of serum sodium during hospitalization were examined based on adherence to one of the following five trajectories: stable normonatremia (47% of patients); uncorrected hyponatremia (15%); borderline high serum sodium (31%); corrected hyponatremia (3%); or fluctuating serum sodium (5%). The researchers emphasized that more than half of the study population had an abnormal serum sodium trajectory during hospitalization.
Findings indicated higher in-hospital mortality among patients with uncorrected hyponatremia (OR = 1.33), borderline high serum sodium (OR = 1.66), corrected hyponatremia (OR = 1.50) and fluctuating serum sodium compared to those with the normonatremia trajectory.
In addition, mortality at 1-year was higher among those with uncorrected hyponatremia (HR = 1.28), borderline high serum sodium (HR = 1.18), corrected hyponatremia (HR = 1.24) and fluctuating serum sodium (HR = 2.10) vs. normonatremia trajectory.
“Our analysis uniquely modeled the serum sodium trajectory for each patient,” the researchers concluded. “To the best of our knowledge, it is the first study of its kind to accomplish this. Our study underscores the value of evaluating the trajectory of the serum sodium rather than a static value.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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