Hyponatremia as a predictor of outcome and mortality: results from a second-level urban emergency department population.

BACKGROUND: Hyponatremia is the most common electrolyte disorder and it has been associated with increased mortality. AIMS: This study evaluated hyponatremia as a prognostic factor for severity and mortality. METHODS: We compared the prevalence of hyponatremia among patients who died during the year 2017 (from 1 January 2017 to 31 December 2017) with the prevalence of hyponatremia among subgroups of patients, i.e. outpatients, patients hospitalized for more than 2 days and patients admitted in the intensive care unit (ICU). We also described the mortality rate and the prevalence of comorbidities among hyponatremic patients, according to hyponatremia degree (slight, moderate, severe), basal characteristics, comorbidities and their outcome (discharged, hospitalized or died). RESULTS: In our population of a public hospital setting, hyponatremia was present at admission in 17% of deaths, and the comparison between hyponatremic and normonatremic patients in terms of mortality confirms the hypothesis that this disorder is in anyway strictly associated with vulnerability and with a poor prognosis. CONCLUSIONS: We conclude that hyponatremia is a predictive marker for a bad clinical course, therefore patients with this electrolyte disorder should be carefully monitored.

Weight loss and P wave dispersion: a preliminary study.

BACKGROUND: The aim of this study is to investigate if therapeutic weight loss reduces P wave dispersion. METHODS: 20 obese patients (10 males and 10 females), part of a randomized clinical trial, were examined over a 6 month period. They were treated with a diet, aiming at 5% weight loss at the 6th month. After physical examination, they underwent laboratory tests, bioelectrical impedance analysis and a electrocardiogram (ECG). ECGs were transferred to a personal computer via a scanner and then magnified 400 times. We examined at baseline and at the 6th month, maximum and minimum P-wave duration, P-wave dispersion and heart rate. RESULTS: Comparing responders (patients who lost 5% of weight at t6) and not responders (who lost less than 5%), responders showed a significant reduction of P wave dispersion value (-0.38 [SD: 0.35] mm equal to -32.3 [SD: 11.3] % p=0.00001). All responders present a reduction of P wave dispersion, while for not-responders this is no longer evident. Finally, a good degree of correlation (r=0.54) between P wave dispersion difference and the decrease of weight was noticed. Females have a better response in P dispersion reduction strictly connected with their weight loss with a good correlation, (r=0.7, p=0.002), versus a moderate correlation evidenced in males (r=0.5, p=0.011). CONCLUSION: P wave duration and dispersion are significantly reduced in patients who lost more than 5% of weight and this decrease is highly related to the extent of weight loss.

Early dropout predictive factors in obesity treatment.

Diet attrition and failure of long term treatment are very frequent in obese patients. This study aimed to identify pre-treatment variables determining dropout and to customise the characteristics of those most likely to abandon the program before treatment, thus making it possible to modify the therapy to increase compliance. A total of 146 outpatients were consecutively enrolled; 73 patients followed a prescriptive diet while 73 followed a novel brief group Cognitive Behavioural Treatment (CBT) in addition to prescriptive diet. The two interventions lasted for six months. Anthropometric, demographic, psychological parameters and feeding behaviour were assessed, the last two with the Italian instrument VCAO Ansisa; than, a semi-structured interview was performed on motivation to lose weight. To identify the baseline dropout risk factors among these parameters, univariate and multivariate logistic models were used. Comparison of the results in the two different treatments showed a higher attrition rate in CBT group, despite no statistically significant difference between the two treatment arms (P = 0.127). Dropout patients did not differ significantly from those who did not dropout with regards to sex, age, Body Mass Index (BMI), history of cycling, education, work and marriage. Regardless of weight loss, the most important factor that determines the dropout appears to be a high level of stress revealed by General Health Questionnaire-28 items (GHQ-28) score within VCAO test. The identification of hindering factors during the assessment is fundamental to reduce the dropout risk. For subjects at risk, it would be useful to dedicate a stress management program before beginning a dietary restriction.