Mortality after Hospitalization with Mild, Moderate, and Severe Hyponatremia

Hyponatremia is present on admission in almost 15% of hospitalized patients. Even mild hyponatremia carries a significantly increased risk of death in hospital. The risk of death associated with hyponatremia appears to be particularly strong in patients with cardiovascular disease, cancer, and those undergoing orthopedic procedures.

Abstract
Background
Hyponatremia is the most common electrolyte abnormality in hospitalized individuals.

Methods
To investigate the association between serum sodium concentration and mortality, we conducted a prospective cohort study of 98,411 adults hospitalized between 2000 and 2003 at 2 teaching hospitals in Boston, Massachusetts. The main outcome measures were in-hospital, 1-year, and 5-year mortality. Multivariable logistic regression and Cox proportional hazards models were used to compare outcomes in patients with varying degrees of hyponatremia against those with normal serum sodium concentration.

Results
Hyponatremia (serum sodium concentration <135 mEq/L) was observed in 14.5% of patients on initial measurement. Compared with patients with normonatremia (135-144 mEq/L), those with hyponatremia were older (67.0 vs 63.1 years, P<.001) and had more comorbid conditions (mean Deyo-Charlson Index 1.9 vs 1.4, P <.001). In multivariable-adjusted models, patients with hyponatremia had an increased risk of death in hospital (odds ratio 1.47, 95% confidence interval [CI], 1.33-1.62), at 1 year (hazard ratio 1.38, 95% CI, 1.32-1.46), and at 5 years (hazard ratio 1.25, 95% CI, 1.21-1.30). The increased risk of death was evident even in those with mild hyponatremia (130-134 mEq/L; odds ratio 1.37, 95% CI, 1.23-1.52). The relationship between hyponatremia and mortality was pronounced in patients admitted with cardiovascular disease, metastatic cancer, and those admitted for procedures related to the musculoskeletal system. Resolution of hyponatremia during hospitalization attenuated the increased mortality risk conferred by hyponatremia.

Conclusion
Hyponatremia, even when mild, is associated with increased mortality.

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-- Sushrut S. Waikar, MD, MPH, David B. Mount, MD, Gary C. Curhan, MD, ScD

This article was originally published in the September 2009 issue of The American Journal of Medicine.