Abstract
Purpose
Hyponatremia is a common and associated with poor clinical outcome in cancer patients. But little is known regarding hyponatremia in terminal cancer patients. The purpose of this study is to investigate the prognostic role of the hyponatremia in terminal cancer patients.
Methods
A retrospective observational study was conducted between January 2010 and December 2012 in a tertiary hospital palliative care unit. Medical records were collected from hospitalized patients who were eligible for obtaining serum sodium level. Hyponatremia was defined as serum sodium <136 mEq/L. And we classified patients into three groups; eunatremia (sodium 136–145 mEq/L), mild to moderate hyponatremia (sodium 126–135 mEq/L), and severe hyponatremia (sodium ≤125 mEq/L). Univariate and multivariate Cox regression analyses were performed to determine factors affecting survival time.
Results
Of the 576 patients, hyponatremia was present in 367 individuals (63.7 %). In the univariate analysis, serum CRP, PPS, and sodium ≤125 mEq/L were associated with survival time (HR = 1.22; p < 0.001, HR = 0.69; p < 0.001, HR = 1.91; p < 0.001). In the multivariate analysis, serum CRP, PPS, sodium 126–135 mEq/L, and sodium ≤125 mEq/L were associated with survival time (HR = 1.16; p < 0.001, HR = 0.70; p < 0.001, HR = 1.19; p = 0.048, HR = 1.75; p < 0.001).
Conclusions
Hyponatremia is an independent prognostic factor in terminal cancer patients and careful clinical concern is needed. In the future, large prospective study is warranted in terminal cancer patients.
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References
Schrier RW (2006) Water and sodium retention in edematous disorders: Role of vasopressin and aldosterone. Am J Med 119:S47–S53. doi:10.1016/j.amjmed.2006.05.007
Upadhyay A, Jaber BL, Madias NE (2009) Epidemiology of hyponatremia. Semin Nephrol 29(3):227–238. doi:10.1016/j.semnephrol.2009.03.004
Waikar SS, Mount DB, Curhan GC (2009) Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med 122(9):857–865. doi:10.1016/j.amjmed.2009.01.027
Wald R, Jaber BL, Price LL, Upadhyay A, Madias NE (2010) Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 170(3):294–302
Zilberberg MD, Exuzides A, Spalding J, Foreman A, Jones AG, Colby C, Shorr AF (2008) Epidemiology, clinical and economic outcomes of admission hyponatremia among hospitalized patients. Curr Med Res Opin 24(6):1601–1608. doi:10.1185/03007990802081675
Doshi SM, Shah P, Lei XD, Lahoti A, Salahudeen AK (2012) Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis 59(2):222–228. doi:10.1053/j.ajkd.2011.08.029
Berghmans T, Paesmans M, Body JJ (2000) A prospective study on hyponatraemia in medical cancer patients: Epidemiology, aetiology and differential diagnosis. Support Care Cancer 8(3):192–197
Raftopoulos H (2007) Diagnosis and management of hyponatremia in cancer patients. Support Care Cancer 15(12):1341–1347. doi:10.1007/s00520-007-0309-9
Sorensen JB, Andersen MK, Hansen HH (1995) Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in malignant disease. J Intern Med 238(2):97–110
Langfeldt LA, Cooley ME (2003) Syndrome of inappropriate antidiuretic hormone secretion in malignancy: Review and implications for nursing management. Clin J Oncol Nurs 7(4):425–430. doi:10.1188/03.CJON. 425-430
Liamis G, Milionis H, Elisaf M (2008) A review of drug-induced hyponatremia. Am J Kidney Dis 52(1):144–153. doi:10.1053/j.ajkd.2008.03.004
Castillo JJ, Vincent M, Justice E (2012) Diagnosis and management of hyponatremia in cancer patients. Oncologist 17(6):756–765. doi:10.1634/theoncologist.2011-0400
Hermes A, Waschki B, Reck M (2012) Hyponatremia as prognostic factor in small cell lung cancer—a retrospective single institution analysis. Respir Med 106(6):900–904. doi:10.1016/j.rmed.2012.02.010
Hansen O, Sorensen P, Hansen KH (2010) The occurrence of hyponatremia in SCLC and the influence on prognosis a retrospective study of 453 patients treated in a single institution in a 10-year period. Lung Cancer 68(1):111–114. doi:10.1016/j.lungcan.2009.05.015
Kawahara M, Fukuoka M, Saijo N, Nishiwaki Y, Ikegami H, Tamura T, Shimoyama M, Suemasu K, Furuse K (1997) Prognostic factors and prognostic staging system for small cell lung cancer. Jpn J Clin Oncol 27(3):158–165
Osterlind K, Andersen PK (1986) Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. Cancer Res 46(8):4189–4194
Jacot W, Colinet B, Bertrand D, Lacombe S, Bozonnat MC, Daures JP, Pujol JL, network Oh (2008) Quality of life and comorbidity score as prognostic determinants in non-small-cell lung cancer patients. Ann Oncol 19(8):1458–1464. doi:10.1093/annonc/mdn064
Jeppesen AN, Jensen HK, Donskov F, Marcussen N, von der Maase H (2010) Hyponatremia as a prognostic and predictive factor in metastatic renal cell carcinoma. Brit J Cancer 102(5):867–872. doi:10.1038/sj.bjc.6605563
Gross P, Reimann D, Henschkowski J, Damian M (2001) Treatment of severe hyponatremia: Conventional and novel aspects. J Am Soc Nephrol 12(2):S10–S14
Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, Orlandi C (2006) Tolvaptan, a selective oral vasopressin V-2-receptor antagonist, for hyponatremia. New Engl J Med 355(20):2099–2112. doi:10.1056/Nejmoa065181
Gheorghiade M, Niazi I, Ouyang J, Czerwiec F, Kambayashi J, Zampino M, Orlandi C, Tolvaptan I (2003) Vasopressin V2-receptor blockade with tolvaptan in patients with chronic heart failure: Results from a double-blind, randomized trial. Circulation 107(21):2690–2696. doi:10.1161/01.CIR.0000070422.41439.04
Gerbes AL, Golberg V, Gines P, Decaux G, Gross P, Gandjini H, Djian J, Grp VS (2003) Therapy of hyponatremia in cirrhosis with a vasopressin receptor antagonist: a randomized double-blind multicenter trial. Gastroenterology 124(4):933–939. doi:10.1053/gast.2003.50143
Saito T, Ishikawa SE, Abe K, Kamoi K, Yamada K, Shimizu K, Saruta T, Yoshida S (1997) Acute aquaresis by the nonpeptide arginine vasopressin (AVP) antagonist OPC-31260 improves hyponatremia in patients with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). J Clin Endocrinol Metab 82(4):1054–1057. doi:10.1210/Jc.82.4.1054
Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Vigano A, Larkin P, De Conno F, Hanks G, Kaasa S (2005) Prognostic factors in advanced cancer patients: Evidence-based clinical recommendations—a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23(25):6240–6248. doi:10.1200/Jco.2005.06.866
Anderson F, Downing GM, Hill J, Casorso L, Lerch N (1996) Palliative performance scale (PPS): a new tool. J Palliat Care 12(1):5–11
Seow H, Barbera L, Dudgeon D, Howell D, Husain A, Atzema C, Sussman J, Liu Y, Earle C, Sutradhar R (2013) The association of the palliative performance scale and hazard of death in an ambulatory cancer population. J Palliat Med 16(2):156–162. doi:10.1089/jpm.2012.0239
Mahmoud FA, Rivera NI (2002) The role of C-reactive protein as a prognostic indicator in advanced cancer. Curr Oncol Rep 4(3):250–255
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We do not have any financial relationships to disclose. We have full control over all primary data and agree to allow Supportive Care in Cancer to review the data.
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Yoon, J., Ahn, S.H., Lee, Y.J. et al. Hyponatremia as an independent prognostic factor in patients with terminal cancer. Support Care Cancer 23, 1735–1740 (2015). https://doi.org/10.1007/s00520-014-2522-7
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DOI: https://doi.org/10.1007/s00520-014-2522-7