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The prevalence and mortality of hyponatremia is seriously underestimated in Chinese general medical patients: an observational retrospective study.

ABSTRACT: Hyponatremia (serum sodium concentration < 135 mmol/L) is the most common electrolyte abnormality and is a predictor of the mortality of hospitalized patients in Western countries. However, hyponatremia data are lacking in Asian countries. Here we evaluate the epidemiology and mortality of hyponatremia in general medical hospitalized patients in China.This is a cohort study of 154,378 adults who were hospitalized between 2008 and 2012 at a teaching hospital in Beijing. We identified hospital patients with hyponatremia and calculated the prevalence and in-hospital mortality of hyponatremia. We also conducted a comprehensive retrospective review of the medical records of patients who had severe hyponatremia (serum sodium <120 mmol/L) during hospitalization in 2012.The overall prevalence of hyponatremia at some point during hospitalization was 17.5% (26,990 patients), but only 0.26% (394 patients) of cases were identified with the diagnostic code of hyponatremia. Hyponatremia was more common in patients with infectious disease, cancer, or cardiovascular disease as the primary reason for hospitalization based on discharge diagnosis, with prevalences of 33.0, 25.9 and 24.9%, respectively. The in-hospital mortality was 0.48% amongst patients without hyponatremia compared to 3.57 and 20.23% in patients with serum sodium levels of 130-134 and <120 mmol/L, resulting in multivariable adjusted odds ratios (ORs) of 4.8 (95% CI 4.3-5.4) and 32.9 (95% CI 25.2-42.3), respectively. The mortality risk increased with increasing severity of hyponatremia in all diagnostic groups. After the multivariate adjustment, only the Charlson Comorbidity Index and age were independently associated with death risk (OR 1.36, 95% CI 1.14-1.64 and OR 1.04, 95% CI 1.00-1.09, respectively) in the patients with severe hyponatremia.Hyponatremia is highly prevalent among Chinese hospitalized patients and is associated with increased in-hospital mortality risk. Physicians should raise awareness to improve the prognosis of hyponatremia.

SUBMITTER: Hao J

PROVIDER: S-EPMC5664828 | biostudies-other | 2017 Oct

REPOSITORIES: biostudies-other

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The prevalence and mortality of hyponatremia is seriously underestimated in Chinese general medical patients: an observational retrospective study.

Hao Jinling J Li Yang Y Zhang Xuehan X Pang Cheng C Wang Yi Y Nigwekar Sagar U SU Qiu Ling L Chen Limeng L

BMC nephrology 20171031 1

<h4>Background</h4>Hyponatremia (serum sodium concentration < 135 mmol/L) is the most common electrolyte abnormality and is a predictor of the mortality of hospitalized patients in Western countries. However, hyponatremia data are lacking in Asian countries. Here we evaluate the epidemiology and mortality of hyponatremia in general medical hospitalized patients in China.<h4>Methods</h4>This is a cohort study of 154,378 adults who were hospitalized between 2008 and 2012 at a teaching hospital in ...[more]

PMID: 29089024

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Project description:Background: Hyponatremia (serum sodium concentration <135 mEq/L) is the most common electrolyte abnormality among hospitalized patients. Our aim was to study the epidemiology of hyponatremia in hospitalized patients, as well as the short-term mortality rates, the length of stay (LOS), and associated hospital costs. Methods: This retrospective cohort study included 6,539 hospitalizations in the internal medicine ward of a Swiss tertiary-care teaching hospital between January 1, 2012, and December 31, 2018 (42.7% women, mean age 69 years). Using serum sodium concentration, we identified hospitalizations with hyponatremia and calculated the prevalence of overall hyponatremia, admission hyponatremia (AH), hospital-acquired hyponatremia (HAH), and persistent hyponatremia (PH) at discharge. We also studied the impact of hyponatremia on 30-day readmissions, in-hospital and 30-day mortality, and hospital LOS and costs, using multivariable logistic regression and Cox proportional hazards models, with normal natremia as reference. Results: Prevalence of overall hyponatremia was 32.5% [95% confidence interval (CI), 31.3-33.6%], while prevalence of PH among hospitalizations with AH and HAH was 33.7% (31.7-35.8%). After multivariable adjustment, hyponatremia was associated with increased hospital costs (CHF 19,025 ± 485 vs. 14,962 ± 341, p < 0.001) and LOS (13.4 ± 0.2 vs. 10.7 ± 0.2 days, p < 0.001). Increased severity of hyponatremia was associated with higher hospital costs and LOS (p for trend <0.001). There was a trend toward more frequent 30-day readmissions associated with hyponatremia [adjusted odds ratio (OR), 1.15 (1.01-1.31), p = 0.032], mainly with PH: adjusted OR = 1.41 (1.17-1.71), p < 0.001. No association was found between severity of hyponatremia and readmissions. Hyponatremia was associated with an increase of in-hospital [adjusted OR = 1.94 (1.49-2.53), p < 0.001] and 30-day mortality: adjusted OR = 1.80 (1.44-2.24), p < 0.001. Increased severity of hyponatremia was associated with higher in-hospital and 30-day mortality (p for trend < 0.001). Conclusions: Hyponatremia is highly prevalent among hospitalized patients and associated with an increase of LOS, early hospital readmission, in-hospital and 30-day mortality, and hospital costs. PH was associated with a substantial increase of the risk of early hospital readmission and 30-day mortality.

Project description:ImportancePremature mortality has been observed among people with mental disorders. Comorbid general medical conditions contribute substantially to this reduction in life expectancy.ObjectiveTo provide an analysis of mortality associated with comorbidity between a broad range of mental disorders and general medical conditions.Design, setting, and participantsPopulation-based cohort study of 5 946 800 individuals born in Denmark from 1900 to 2015 and residing in the country at the start of follow-up (January 1, 2000, or their date of birth, whichever occurred later).ExposuresDanish health registers were used to identify people with mental disorders and general medical conditions.Main outcomes and measuresConsidering pairs of mental disorders and general medical conditions, we calculated mortality rate ratios (MRRs) and differences in life expectancy (ie, life-years lost) to assess the association of mortality with both disorders of interest compared with the mental disorder of interest, the general medical condition of interest, and neither disorder of interest.ResultsThe study population comprised 2 961 397 males and 2 985 403 females, with a median (IQR) age of 32.0 years (7.3-52.9) at start of follow-up and 48.9 years (42.5-68.8) at the end. Based on all pairs of comorbid mental disorders and general medical conditions, the mean MRR compared with people without these conditions was 5.90 (median, 4.94; IQR, 3.80-7.30), and the mean reduction of life expectancy compared with the general population was 11.35 years (median, 11.08; range, 5.27-23.53; IQR, 8.22-13.72). The association with general medical condition comorbidity in those with mental disorders varied by general medical condition; for example, the addition of a neurological condition for each of the mental disorders was associated with a mean MRR of 1.22, whereas for cancer, the mean MRR for all mental disorders was 4.07.Conclusions and relevanceIn this study, shorter life expectancy was associated with comorbid mental disorders and general medical conditions compared with the entire population and also when compared with patients who had either mental disorders only or general medical conditions only. Prevention and early detection of comorbidities could reduce premature mortality in patients with mental disorders.

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The prevalence and mortality of hyponatremia is seriously underestimated in Chinese general medical patients: an observational retrospective study.

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The prevalence and mortality of hyponatremia is seriously underestimated in Chinese general medical patients: an observational retrospective study.

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