The Economic Burden of Hyponatremia: Systematic Review And Meta-Analysis.
Am J Med. 2016 Apr 4;
Authors: Corona G, Giuliani C, Parenti G, Colombo GL, Sforza A, Maggi M, Forti G, Peri A
BACKGROUND: Hyponatremia is the most common electrolyte abnormality observed in clinical practice. Several studies have demonstrated that hyponatremia is associated with an increased length of hospital stay and of hospital resource utilization. To clarify the impact of hyponatremia on the length of hospitalization and costs, we performed a meta-analysis based on published studies that compared hospital length of stay and cost between patients with or without hyponatremia.
METHODS: An extensive Medline, Embase and Cochrane search was performed to retrieve all studies published up to April 1(st) 2015, using the following words: "hyponatremia" or "hyponatraemia" AND "hospitalization" or "hospitalization". A meta-analysis was performed including all studies comparing duration of hospitalization and hospital readmission rate in subjects with and without hyponatremia.
RESULTS: Out of 444 retrieved articles, 46 studies satisfied the inclusion criteria encompassing a total of 3,940,042 patients; among these 757,763 (19·2%) were hyponatremic. Across all studies hyponatremia was associated with a significantly longer duration of hospitalization (3·30[2·90;3·71] mean days; p<0·000). Similar results were obtained when patients with associated morbidities were analyzed separately. Furthermore, hyponatremic patients had a higher risk of readmission after the first hospitalization (OR=1·32[1·18;1·48]; p<0·000). A meta-regression analysis showed that the hyponatremia-related length of hospital stay was higher in males (S=0·09[0·05;0·12];p=0·000 and I=-1·36[-3·03;0·32]; p=0·11) and in elderly patients (S=0·002[0·001;0·003];p<0·000 and I=0·89[0·83;0·97]; p<0·001). A negative association between serum [Na(+)] cut-off and duration of hospitalization was detected. No association between duration of hospitalization, serum [Na(+)] and associated morbidities was observed. Finally, when only US studies (n=8) were considered, hyponatremia was associated with up to $3,000 higher hospital costs/patient when compared to the cost of normonatremic subjects.
CONCLUSIONS: This meta-analysis confirms that hyponatremia is associated with a prolonged hospital length of stay, and higher risk of readmission. These observations suggest that hyponatremia may represent one important determinant of the hospitalization costs.
PMID: 27059386 [PubMed - as supplied by publisher]