Hospital-Associated Hypernatremia Spectrum and Clinical Outcomes in an Unselected Cohort.
Am J Med. 2017 Aug 28;:
Authors: Tsipotis E, Price LL, Jaber BL, Madias NE
BACKGROUND: Although hypernatremia is associated with adverse outcomes, most studies examined selected populations.
METHODS: Discharge data of 19,072 unselected hospitalized adults were analyzed. The crude relationship between serum [Na(+)] and mortality defined hypernatremia as serum [Na(+)] > 142 mEq/L. Patients with community-acquired hypernatremia or hospital-acquired hypernatremia were compared to normonatremic patients (admission [Na(+)] 138-142 mEq/L) regarding in-hospital mortality, length of stay, and discharge disposition. Patients with community-acquired hypernatremia whose hypernatremia worsened during hospitalization were compared to those without aggravation.
RESULTS: Community-acquired hypernatremia occurred in 21% of hospitalized patients and was associated with an adjusted odds ratio (OR) of 1.67 (95% confidence interval [CI] 1.38, 2.01) for in-hospital mortality, and 1.44 (95% CI 1.32, 1.56) for discharge to a short-/long-term care facility, and an adjusted 10% (95% CI, 7%-13%) increase in length of stay. Hospital-acquired hypernatremia developed in 25.9% of hospitalized patients and was associated with an adjusted OR of 3.17 (95% CI 2.45, 4.09) for in-hospital mortality, and 1.45 (95% CI 1.32, 1.59) for discharge to a facility, and an adjusted 49% (95% CI 44%, 53%) increase in length of stay. Hospital-aggravated hypernatremia developed in 11.7% of patients with community-acquired hypernatremia and was associated with greater risk of in-hospital mortality (adjusted OR 1.84; 95% CI 1.32, 2.56) and discharge to a facility (adjusted OR 2.14; 95% CI 1.71, 2.69), and an adjusted 16% (95% CI 7%-27%) increase in length of stay.
CONCLUSIONS: The hypernatremia spectrum in unselected hospitalized patients is independently associated with increased in-hospital mortality and heightened resource consumption.
PMID: 28860033 [PubMed - as supplied by publisher]