Archives of Orthopaedic and Trauma Surgery

, Volume 133, Issue 4, pp 507–511 | Cite as

Hyponatremia at admission is associated with in-hospital death in patients with hip fracture

  • Tetsuo Hagino
  • Satoshi Ochiai
  • Yoshiyuki Watanabe
  • Shinya Senga
  • Masanori Saito
  • Yoshihiro Takayama
  • Masanori Wako
  • Takashi Ando
  • Eiichi Sato
  • Hirotaka Haro
Trauma Surgery



Hyponatremia in hospitalized patients has been reported to be associated with in-hospital mortality. We studied patients treated at our hospital for hip fracture regarding the factors related to hyponatremia at admission.


Among 580 patients aged 60 years or above who were admitted to our hospital since January 1997 for treatment of hip fracture, 512 patients (110 males, 402 females) from whom serum sodium level at admission was available were studied. In 512 patients, the age at injury ranged from 60 to 103 (mean 82.6) years. Fracture types were femoral neck fracture in 191 patients, and trochanteric fracture in 321. These patients were divided into two groups by the blood sodium level at admission: a hyponatremia group with sodium levels lower than 135 mEq/L, and a normonatremia group with sodium levels within normal range. The age, gender, fracture type, residence before injury, pre-injury walking capability, anemia at admission, liver function, kidney function, inflammatory status, urinary glucose status, lung disease, ECG abnormality, systemic chronic disease, status of dementia, treatment modality, hospital stay (days), and in-hospital death were investigated. First a univariate study was conducted to identify the factors that differ significantly between the two groups. Then multivariate analysis was conducted using the parameters with significant difference as independent variables


Hyponatremia was found in 49 of 512 (9.6 %) patients. In univariate analyses, six factors (age; residence before injury; anemia; dementia; treatment modality; in-hospital death) were significantly different between the hyponatremia group and normonatremia group. Multivariate analysis identified in-hospital death [odds ratio (OR) = 3.64, p = 0.035] and age (OR = 1.05, p = 0.029) as independently associated with hypernatremia.


Hyponatremia at admission is prevalent in old aged patients with fracture, and is related to in-hospital death.


Hip fracture Hyponatremia Mortality 


Conflict of interest



  1. 1.
    Antonelli Incalzi R, Gemma A, Capparella O, Terranova L, Sanguinetti C, Carbonin PU (1993) Post-operative electrolyte imbalance: its incidence and prognostic implications for elderly orthopaedic patients. Age Ageing 22(5):325–331PubMedCrossRefGoogle Scholar
  2. 2.
    Asadollahi K, Beeching N, Gill G (2006) Hyponatraemia as a risk factor for hospital mortality. QJM : Mon Assoc Physicians 99(12):877–880CrossRefGoogle Scholar
  3. 3.
    Beloosesky Y, Hershkovitz A, Solovey B, Salai M, Weiss A (2011) Hip fracture post-operation dysnatremia and Na+-courses in different cognitive and functional patient groups. Arch Gerontol Geriatr 53(2):179–182PubMedCrossRefGoogle Scholar
  4. 4.
    Bentler SE, Liu L, Obrizan M et al (2009) The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 170(10):1290–1299PubMedCrossRefGoogle Scholar
  5. 5.
    Chawla A, Sterns RH, Nigwekar SU, Cappuccio JD (2011) Mortality and serum sodium: do patients die from or with hyponatremia? Clin J Am Soc Nephrolo :CJASN 6(5):960–965CrossRefGoogle Scholar
  6. 6.
    Chin TL, Liu G, Shen L, Hee KW (2010) A decade of in-hospital fracture mortality review: an analysis of 8700 patients. J Bone Jt Surg 92(1):496–497Google Scholar
  7. 7.
    Flear CT, Singh CM (1973) Hyponatraemia and sick cells. Br J Anaesth 45(9):976–994PubMedCrossRefGoogle Scholar
  8. 8.
    Frenkel WN, van den Born BJ, van Munster BC, Korevaar JC, Levi M, de Rooij SE (2010) The association between serum sodium levels at time of admission and mortality and morbidity in acutely admitted elderly patients: a prospective cohort study. J Am Geriatr Soc 58(11):2227–2228PubMedCrossRefGoogle Scholar
  9. 9.
    Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV (2011) Risk factors for in-hospital post-hip fracture mortality. Bone 49(3):553–558PubMedCrossRefGoogle Scholar
  10. 10.
    Funk G-C, Lindner G, Druml W et al (2010) Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med 36(2):304–311PubMedCrossRefGoogle Scholar
  11. 11.
    Gill G, Huda B, Boyd A et al (2006) Characteristics and mortality of severe hyponatraemia—a hospital-based study. Clin Endocrinol 65(2):246–249CrossRefGoogle Scholar
  12. 12.
    Gill G, Leese G (1998) Hyponatraemia: biochemical and clinical perspectives. Postgrad Med J 74(875):516–523PubMedCrossRefGoogle Scholar
  13. 13.
    Hagino T, Ochiai S, Wako M, Sato E, Maekawa S, Hamada Y (2008) Twin hook fixation for proximal femoral fractures. J Orthop Surg (Hong Kong) 16(2):162–164Google Scholar
  14. 14.
    Hagino T, Sato E, Tonotsuka H, Ochiai S, Tokai M, Hamada Y (2006) Prediction of ambulation prognosis in the elderly after hip fracture. Int Orthop 30(5):315–319PubMedCrossRefGoogle Scholar
  15. 15.
    Hoorn EJ, Liamis G, Zietse R, Zillikens MC (2012) Hyponatremia and bone: an emerging relationship. Nat Rev Endocrinol 8(1):33–39CrossRefGoogle Scholar
  16. 16.
    Jiang HX, Majumdar SR, Dick DA et al (2005) Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Mineral Res 20(3):494–500CrossRefGoogle Scholar
  17. 17.
    Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50(10):1644–1650PubMedCrossRefGoogle Scholar
  18. 18.
    Lewis JR, Hassan SKZ, Wenn RT, Moran CG (2006) Mortality and serum urea and electrolytes on admission for hip fracture patients. Injury 37(8):698–704PubMedCrossRefGoogle Scholar
  19. 19.
    Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1989) Survival experience of aged hip fracture patients. Am J Public Health 79(3):274–278PubMedCrossRefGoogle Scholar
  20. 20.
    McPherson E, Dunsmuir RA (2002) Hyponatraemia in hip fracture patients. Scott Med J 47(5):115–116PubMedGoogle Scholar
  21. 21.
    Pimlott BJ, Jones CA, Beaupre LA, Johnston DW, Majumdar SR (2011) Prognostic impact of pre-operative albumin on short-term mortality and complications in patients with hip fracture. Arch Gerontol Geriatr 53(1):90–94PubMedCrossRefGoogle Scholar
  22. 22.
    Waikar SS, Mount DB, Curhan GC (2009) Mortality after Hospitalization with Mild, Moderate, and Severe Hyponatremia. Am J Med 122(9):857–865PubMedCrossRefGoogle Scholar
  23. 23.
    Wald R, Jaber BL, Price LL, Upadhyay A, Madias NE (2010) Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 170(3):294–302PubMedCrossRefGoogle Scholar
  24. 24.
    Whelan B, Bennett K, O’Riordan D, Silke B (2009) Serum sodium as a risk factor for in-hospital mortality in acute unselected general medical patients. QJM : Mon J Assoc Phys 102(3):175–182Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Tetsuo Hagino
    • 1
  • Satoshi Ochiai
    • 1
  • Yoshiyuki Watanabe
    • 1
  • Shinya Senga
    • 1
  • Masanori Saito
    • 2
  • Yoshihiro Takayama
    • 2
  • Masanori Wako
    • 2
  • Takashi Ando
    • 2
  • Eiichi Sato
    • 2
  • Hirotaka Haro
    • 2
  1. 1.Department of Orthopaedic Surgery, National Hospital OrganizationKofu National HospitalKofuJapan
  2. 2.Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and EngineeringUniversity of YamanashiChuoJapan

Personalised recommendations