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Impact of Hospital-Associated Hyponatremia on Selected Outcomes
Ron Wald, MDCM, MPH;
Bertrand L. Jaber, MD, MS;
Lori Lyn Price, MS;
Ashish Upadhyay, MD;
Nicolaos E. Madias, MD
Arch Intern Med. 2010;170(3):294-302.
Background Hyponatremia is the most common electrolyte disorder encountered in hospitalized patients.
Methods We evaluated whether hospital-associated hyponatremia has an independent effect on all-cause mortality, hospital length of stay (LOS), and patient disposition. This cohort study included all adult hospitalizations at an academic medical center occurring between 2000-2007 for which an admission serum sodium concentration ([Na+]) was available (N = 53 236). We examined community-acquired hyponatremia (admission serum [Na+], <138 mEq/L [to convert to millimoles per liter, multiply by 1.0]), hospital-aggravated hyponatremia (community-acquired hyponatremia complicated by worsening in serum [Na+]), and hospital-acquired hyponatremia (nadir serum [Na+], <138 mEq/L with a normal admission serum [Na+]). The independent associations of these hyponatremic presentations with in-hospital mortality, LOS, and patient disposition were evaluated using generalized estimating equations adjusted for age, sex, race, admission service, and Deyo-Charlson Comorbidity Index score.
Results Community-acquired hyponatremia occurred in 37.9% of hospitalizations and was associated with adjusted odds ratios (ORs) of 1.52 (95% confidence interval [CI], 1.36-1.69) for in-hospital mortality and 1.12 (95% CI, 1.08-1.17) for discharge to a short- or long-term care facility and a 14% (95% CI, 11%-16%) adjusted increase in LOS. Hospital-acquired hyponatremia developed in 38.2% of hospitalizations longer than 1 day in which initial serum [Na+] was 138 to 142 mEq/L. Hospital-acquired hyponatremia was associated with adjusted ORs of 1.66 (95% CI, 1.39-1.98) for in-hospital mortality and 1.64 (95% CI, 1.55-1.74) for discharge to a facility and a 64% (95% CI, 60%-68%) adjusted increase in LOS. The strength of these associations tended to increase with hyponatremia severity.
Conclusions Hospital-associated hyponatremia is a common occurrence. All forms of hyponatremia are independently associated with in-hospital mortality and heightened resource consumption.
Author Affiliations: Division of Nephrology, St Michael's Hospital and University of Toronto, and Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (Dr Wald); Department of Medicine, St Elizabeth's Medical Center and Tufts University School of Medicine, Boston, Massachusetts (Drs Jaber and Madias); Biostatistics Research Center, Tufts Medical Center, Boston (Ms Price); and Division of Nephrology, Tufts Medical Center and Tufts University School of Medicine (Dr Upadhyay).
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