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Hypernatremia at Hospital Discharge and Out of Hospital Mortality Following Primary Intracerebral Hemorrhage

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Abstract

Background and Purpose

In patients with intracerebral hemorrhage (ICH), it is not clear if hypernatremia is merely a marker of disease severity or if elevated sodium levels are harmful. We hypothesized that hypernatremia at hospital discharge in primary ICH patients would be associated with increased mortality following discharge.

Methods

We performed a two-center observational study of critically ill ICH patients in Boston. We studied 5100 patients, age ≥18 years, who were diagnosed with ICH (ICD-9 code 431), received medical or surgical critical care between 1997 and 2011 and survived hospitalization. The exposure of interest was serum sodium within 24 h of hospital discharge, categorized as Na ≤ 145 mmol/L and Na > 145 mmol/L. The primary outcome was 30-day post-discharge mortality. Odds ratios were estimated by logistic regression models adjusted for age, race, gender, Deyo–Charlson Index, patient type (medical versus surgical) and sepsis.

Results

In ICH patients who received critical care and survived hospitalization, the serum sodium at discharge was a predictor of post-discharge mortality. Patients with a discharge Na > 145 mmol/L have an OR for mortality in the 30 days following hospital discharge of 1.82 (95 %CI 1.38–2.38; P < 0.001) and an adjusted OR of 1.87 (95 %CI 1.40–2.48; P < 0.001) both relative to patients with a discharge Na ≤ 145 mmol/L. The adjusted model showed good discrimination AUC 0.77 (95 %CI 0.74–0.79) and calibration (Hosmer–Lemeshow χ 2 P = 0.68).

Conclusions

In critically ill ICH patients who survive hospitalization, hypernatremia at the time of discharge is a robust predictor of post-discharge mortality.

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Acknowledgments

This manuscript is dedicated to the memory of our dear friend and colleague Nathan Edward Hellman, MD, PhD. The authors thank Shawn Murphy and Henry Chueh and the Partners HealthCare Research Patient Data Registry group for facilitating use of their database. Dr. Christopher had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

NIH R01 NS059727.

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Correspondence to Kenneth B. Christopher.

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Boland, T., Henderson, G.V., Gibbons, F.K. et al. Hypernatremia at Hospital Discharge and Out of Hospital Mortality Following Primary Intracerebral Hemorrhage. Neurocrit Care 25, 110–116 (2016). https://doi.org/10.1007/s12028-015-0234-6

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