Systemic and iatrogenic factors contribute to the development of severe hypernatraemia in vulnerable inpatients.
Clin Endocrinol (Oxf)
; 100(4): 350-357, 2024 04.
Article
en En
| MEDLINE
| ID: mdl-37807424
ABSTRACT
OBJECTIVES:
To determine all-cause in-hospital mortality associated with severe hypernatraemia and the causes, comorbidities, time to treatment, discharge destination and postdischarge mortality.DESIGN:
Retrospective observational cohort study. PATIENTS Severe hypernatraemia, (sodium concentration ≥ 155 mmol/L), at any time during a tertiary hospital admission in Melbourne, Australia, 1 January 2019 to 31 December 2019 (pre-COVID19). MEASUREMENTS Deaths, Charlson Comorbidity Index (CCI), hypernatraemia causes, time to treatment, discharge destination.RESULTS:
One hundred and one inpatients 64 community-acquired, 37 hospital-acquired. In-hospital mortality was 38%, but cumulative mortality was 65% by 1 month after discharge, with only a minor further increase at 6 and 12 months. After adjusting for peak sodium concentration, the community acquired group had significantly reduced odds of in-hospital mortality (odds ratio 0.15, 95% confidence interval [0.04-0.54], p = .003). Iatrogenic factors were present in 57% (21/37) of the hospital-acquired group. Only 55% of all cases received active sodium directed treatment. Time to start treatment did not affect outcomes. High levels of comorbidity were present, median CCI (IQR) was 6 (5-8) in the community and 5 (4-7) in the hospital group. Dementia prevalence was higher in the community group, 66% (42/64) versus 19% (7/37) (p = .001). Infection was the most common precipitant with 52% (33/64) in the community and 32% (12/37) in the hospital group. Of the survivors, 32% who had been living independently required residential care after discharge.CONCLUSIONS:
Mortality was high and loss of independence in survivors common. To potentially improve outcomes, hypernatraemia-specific guidelines should be formulated and efforts made to reduce system and iatrogenic factors.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Hipernatremia
Tipo de estudio:
Guideline
/
Observational_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
Clin Endocrinol (Oxf)
Año:
2024
Tipo del documento:
Article
País de afiliación:
Australia