Skip to main content
SpringerLink
Log in

Mortality predictors of patients diagnosed with severe hyponatremia in the emergency department

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Purpose

To determine the factors affecting mortality as a result of the analysis of the demographic and clinical characteristics and laboratory parameters of patients whose serum Na value was determined to be 125 mEq/L or below at the time of admission to the emergency department (ED).

Method

Patients over 18 years of age who admitted to the ED of a tertiary hospital between September 2021 and September 2022 and whose serum sodium level was determined to be 125 mEq/L and below were included in the study. Demographic and clinical characteristics, admission complaints, medications used, Charles comorbidity index (CCI), laboratory parameters, and outcomes of the patients included in the study were recorded in the data form.

Results

Three hundred ninety-nine patients were included in the study. When the 30-day mortality of the patients is examined, the mortality rate was found to be 21.6%. In the analyses performed for the predictive power of laboratory parameters for mortality, it was determined that the highest predictive power among the predictive values determined by the area under the curve (AUC) was the albumin level (AUC 0.801, 95% CI 0.753–0.849, p < 0.001). In the binary logistic regression analysis, urea and albumin were independent predictors of 30-day mortality.

Conclusion

According to study data, albumin and urea levels are independent predictors of 30-day mortality in patients diagnosed with severe hyponatremia in the emergency department.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and material

The full dataset on which analyses were run is available upon written request to the corresponding author.

References

  1. Hsu YJ, Chiu JS, Lu KC et al (2005) Biochemical and etiological characteristics of acute hyponatremia in the emergency department. J Emerg Med 29(4):369–374

    Article  PubMed  Google Scholar 

  2. Nguyen MK, Ornekian V, Butch AW et al (2007) A new method for determining plasma water content: application in pseudohyponatremia. Am J Physiol Renal Physiol 292:F1652–F1656

    Article  CAS  PubMed  Google Scholar 

  3. Rose BD, Post TW (2001) Clinical physiology of acid-base and electrolyte disorders, 5th edn. McGraw-Hill, New York, p 699

    Google Scholar 

  4. Katz MA (1973) Hyperglycemia-induced hyponatremia calculation of expected serum sodium depression. N Engl J Med 289(16):843–844

    Article  CAS  PubMed  Google Scholar 

  5. Bähr V, Franzen NF, Pfeiffer AF et al (2006) Vasopressin excess and hyponatremia: hydrocortisone treatment should be considered. Am J Kidney Dis 48(2):339

    Article  PubMed  Google Scholar 

  6. Spasovski G, Vanholder R, Allolio B et al (2014) Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 29(2):1–39

    Article  Google Scholar 

  7. Hoorn EJ, Zietse R (2017) Diagnosis and treatment of hyponatremia: compilation of the guidelines. J Am Soc Nephrol 28(5):1340–1349

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ball SG, Iqbal Z (2016) Diagnosis and treatment of hyponatraemia. Best Pract Res Clin Endocrinol Metab 30(2):161–173

    Article  CAS  PubMed  Google Scholar 

  9. Upadhyay A, Jaber BL, Madias NE (2006) Incidence and prevalence of hyponatremia. Am J Med 119(1):30–35

    Article  Google Scholar 

  10. Christ-Crain M (2016) Profound hyponatraemia in the emergency department: a hot topic. Swiss Med Wkly 146:14396

    Google Scholar 

  11. Olsson K, Öhlin B, Melander O (2013) Epidemiology and characteristics of hyponatremia in the emergency department. Eur J Intern Med 24(2):110–116

    Article  CAS  PubMed  Google Scholar 

  12. Mohan S, Gu S, Parikh A et al (2013) Prevalence of hyponatremia and association with mortality: results from NHANES. Am J Med 126(12):1127–1137

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Terzian C, Frye EB, Piotrowski ZH (1994) Admission hyponatremia in the elderly: factors influencing prognosis. J Gen Intern Med 9(2):89–91

    Article  CAS  PubMed  Google Scholar 

  14. Giordano M, Ciarambino T, Castellino P et al (2016) Diseases associated with electrolyte imbalance in the ED: age-related differences. Am J Emerg Med 34(10):1923–1926

    Article  PubMed  Google Scholar 

  15. Lindner G, Pfortmuller CA, Leichtle AB et al (2014) Age-related variety in electrolyte levels and prevalence of dysnatremias and dyskalemias in patients presenting to the emergency department. Gerontology 60(5):420–423

    Article  PubMed  Google Scholar 

  16. Chewcharat A, Thongprayoon C, Cheungpasitporn W et al (2020) Trajectories of serum sodium on ın-hospital and 1-year survival among hospitalized patients. Clin J Am Soc Nephrol 15:600–607

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Thongprayoon C, Cheungpasitporn W, Petnak T et al (2020) The prognostic importance of serum sodium levels at hospital discharge and one-year mortality among hospitalized patients. Int J Clin Pract 74:13581

    Article  Google Scholar 

  18. Zilberberg MD, Exuzides A, Spalding J et al (2008) Hyponatremia and hospital outcomes among patients with pneumonia: a retrospective cohort study. BMC Pulm Med 8:16

    Article  PubMed  PubMed Central  Google Scholar 

  19. Klein L, O’Connor CM, Leimberger JD, OPTIME-CHF ınvestigators et al (2005) Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the outcomes of a prospective trial of intravenous milrinone for exacerbations of chronic heart failure (OPTIME-CHF) study. Circulation 111:2454–2460

    Article  CAS  PubMed  Google Scholar 

  20. Waikar SS, Mount DB, Curhan GC (2009) Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med 122:857–865

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Kim WR, Biggins SW, Kremers WK et al (2008) Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 359:1018–1026

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Stelfox HT, Ahmed SB, Khandwala F et al (2008) The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care 12:R162

    Article  PubMed  PubMed Central  Google Scholar 

  23. Clayton JA, Le Jeune IR, Hall IP (2006) Severe hyponatremia in medical in-patients: aetiology, assessment and outcome. Q J Med 99:505–511

    Article  CAS  Google Scholar 

  24. Renneboog B, Musch W, Vandemergel X et al (2006) Mild chronic hyponatremia is associated with falls, unsteadiness and attention deficits. Am J Med 119:711–718

    Article  Google Scholar 

  25. Kengne FG, Andres C, Sattar L et al (2008) Mild hyponatremia and risk of fracture in the ambulatory elderly. Q J Med 101:583–588

    Article  Google Scholar 

  26. Charlson M, Pompei P, Ales K, MacKenzie C (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  27. Dağar S, Akıncı Emektar E, Çorbacıoğlu ŞK et al (2019) Medico-legal evaluation of geriatric patients and mortality predictors in the elderly with forensic trauma. Ankara Med J 19(4):761–768

    Article  Google Scholar 

  28. Liamis G, Filippatos TD, Elisaf MS (2016) Thiazide-associated hyponatremia in the elderly: what the clinician needs to know. J Geriatr Cardiol 13(2):175–182

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Huwyler T, Stirnemann J, Vuilleumier N et al (2016) Profound hyponatraemia in the emergency department: seasonality and risk factors. Swiss Med Wkly 146:14385

    Google Scholar 

  30. Jain AK, Nandy P (2019) Clinico-etiological profile of hyponatremia among elderly age group patients in a tertiary care hospital in Sikkim. J Family Med Prim Care 8(3):988–994

    Article  PubMed  PubMed Central  Google Scholar 

  31. Abramow M, Cogan E (1984) Clinical aspects and pathophysiology of diuretic-induced hyponatremia. Adv Nephrol Necker Hosp 13:1–28

    CAS  PubMed  Google Scholar 

  32. Sonnenblick M, Friedlander Y, Rosin AJ (1993) Diuretic-induced severe hyponatremia: review and analysis of 129 reported patients. Chest 103(2):601–606

    Article  CAS  PubMed  Google Scholar 

  33. Rao MY, Sudhir U, Anil Kumar T et al (2010) Hospital-based descriptive study of symptomatic hyponatremia in elderly patients. J Assoc Physicians India 58:667–669

    CAS  PubMed  Google Scholar 

  34. Turgutalp K, Ozhan O, Gok Oguz E et al (2013) Clinical features, outcome and cost of hyponatremia-associated admission and hospitalization in elderly and very elderly patients: a single-center experience in Turkey. Int Urol Nephrol 45(1):265–273

    Article  CAS  PubMed  Google Scholar 

  35. Gosch M, Joosten-Gstrein B, Heppner H-J et al (2012) Hyponatremia in geriatric inhospital patients: effects on results of a comprehensive geriatric assessment. Gerontology 58(5):430–440

    Article  CAS  PubMed  Google Scholar 

  36. Zhang X, Li XY (2020) Prevalence of hyponatremia among older inpatients in a general hospital. Eur Geriatr Med 11(4):685–692

    Article  PubMed  PubMed Central  Google Scholar 

  37. Morris PE, Griffin L, Berry M et al (2011) Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci 341(5):373–377

    Article  PubMed  PubMed Central  Google Scholar 

  38. Keil DS, Gross S, Seymour RB et al (2018) Mortality after high-energy pelvic fractures in patients of age 65 years or older. J Orthop Trauma 32(3):124–128

    Article  PubMed  Google Scholar 

  39. Matsuo K, Mandelbaum RS, Adams CL et al (2019) Performance and outcome of pelvic exenteration for gynecologic malignancies: a population-based study. Gynecol Oncol 153(2):368–375

    Article  PubMed  PubMed Central  Google Scholar 

  40. Winzeler B, Jeanloz N, Nigro N et al (2016) Long-term outcome of profound hyponatremia: a prospective 12 months follow-up study. Eur J Endocrinol 175(6):499–507

    Article  CAS  PubMed  Google Scholar 

  41. Bozkurt Babuş S, Köse A, Erdogan S et al (2023) Risk factors and mortality in elderly patients with severe hyponatremia admitted to the emergency department. Ir J Med Sci 192(2):861–870

    Article  PubMed  Google Scholar 

  42. Hao J, Li Y, Zhang X et al (2017) The prevalence and mortality of hyponatremia is seriously underestimated in Chinese general medical patients: an observational retrospective study. BMC Nephrol 18:328

    Article  PubMed  PubMed Central  Google Scholar 

  43. Liamis G, Milionis HJ, Elisaf M (2011) Hyponatremia in patients with infectious diseases. J Infect 63(5):327–335

    Article  PubMed  Google Scholar 

  44. Lee CT, Guo HR, Chen JB (2000) Hyponatremia in the emergency department. Am J Emerg Med 18(3):264–268

    Article  CAS  PubMed  Google Scholar 

  45. Arampatzis S, Frauchiger B, Fiedler GM et al (2012) Characteristics, symptoms, and outcome of severe dysnatremias present on hospital admission. Am J Med 125(11):1125–2112

    Article  Google Scholar 

  46. Ellison DH, Berl T, Clinical practice (2007) The syndrome of inappropriate antidiuresis. N Engl J Med 356(20):2064–2072

    Article  CAS  PubMed  Google Scholar 

  47. Cuesta M, Slattery D, Goulden EL et al (2019) Hyponatraemia in patients with community-acquired pneumonia; prevalence and aetiology, and natural history of SIAD. Clin Endocrinol (Oxf) 90(5):744–752

    Article  CAS  PubMed  Google Scholar 

  48. Chung HM, Kluge R, Schrier RW, Anderson RJ (1987) Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 83(5):905–908

    Article  CAS  PubMed  Google Scholar 

  49. Pham PC, Pham PM, Pham PT (2006) Vasopressin excess and hyponatremia. Am J Kidney Dis 47(5):727–737

    Article  CAS  PubMed  Google Scholar 

  50. Dandona P, Fonseca V, Baron DN (1985) Hypoalbuminaemic hyponatraemia: a new syndrome? Br Med J (Clin Res Ed) 291(6504):1253–1255

    Article  CAS  PubMed  Google Scholar 

  51. Zoellner H, Hofler M, Beckmann R et al (1996) Serum albumin is a specific inhibitor of apoptosis in human endothelial cells. J Cell Sci 109(10):2571–2580

    Article  CAS  PubMed  Google Scholar 

  52. Fleck A, Hawker F, Wallace P et al (1985) Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury. The Lancet 325(8432):781–784

    Article  Google Scholar 

  53. Nicholson JP, Wolmarans MR, Park GR (2000) The role of albumin in critical illness. Br J Anaesth 85:599–610

    Article  CAS  PubMed  Google Scholar 

  54. Goldwasser P, Feldman J (1997) Association of serum albumin and mortality risk. J Clin Epidemiol 50(6):693–703

    Article  CAS  PubMed  Google Scholar 

  55. Knaus WA, Wagner DP, Draper EA et al (1991) The APACHE III prognostic system: risk prediction of hospital mortality for critically III hospitalized adults. Chest 100(6):1619–1636

    Article  CAS  PubMed  Google Scholar 

  56. Investigators SS (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350(22):2247–2256

    Article  Google Scholar 

  57. Tanemoto M (2008) Effect of serum albumin on serum sodium: necessity to consider the Donnan effect. QJM 101(10):827–828

    Article  CAS  PubMed  Google Scholar 

  58. Pan SW (2013) Synergistic impact of low serum albumin on intensive care unit admission and high blood urea nitrogen during intensive care unit stay on post intensive care unit mortality in critically ill elderly patients requiring mechanical ventilation. Geriatr Gerontol Int 13(1):107

    Article  PubMed  Google Scholar 

  59. Tokgöz Akyıl F, Akyıl M, Çoban Agca M et al (2019) Hyponatremia prolongs hospital stay and hypernatremia better predicts mortality than hyponatremia in hospitalized patients with community-acquired pneumonia. Tuberk Toraks 67(4):239–247

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Ministry of Health Kilis Prof. Dr. Alaeddin Yavasca Hospital, Kilis, Turkey

    Mesut Gurbuz

  2. Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey

    Selen Acehan, Salim Satar, Muge Gulen & Sarper Sevdımbas

  3. Department of Emergency Medicine, Ministry of Health Bursa Karacabey Hospital, Bursa, Turkey

    Cagdas Ince

  4. Department of Nephrology, Adana Baskent University, Adana, Turkey

    Engin Onan

Authors
  1. Mesut Gurbuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Selen Acehan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Salim Satar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Muge Gulen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarper Sevdımbas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cagdas Ince
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Engin Onan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MG, SA, SS, MG, SS, CI, and EO conceived and designed the study; MG, SA, SS, MG, and EO selected the articles and extracted the data; MG, SA, MG, SS, and CI analyzed the data and interpreted the results; MG, SA, SS, MG, SS, CI, and EO contributed to writing the final version of the manuscript. All authors agreed with the results and conclusions of this article.

Corresponding author

Correspondence to Selen Acehan.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gurbuz, M., Acehan, S., Satar, S. et al. Mortality predictors of patients diagnosed with severe hyponatremia in the emergency department. Ir J Med Sci (2024). https://doi.org/10.1007/s11845-024-03615-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11845-024-03615-7

Keywords

Search

Navigation