1
|
Wichmann S, Rønhøj R, Ellekjær KL, Møller MH, Bestle MH. Hypernatremia in hospitalised adult patients: A protocol for a scoping review. Acta Anaesthesiol Scand 2024; 68:1541-1543. [PMID: 38960593 DOI: 10.1111/aas.14491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Hypernatremia is a common electrolyte disturbance in hospitalised patients associated with adverse outcomes. The aetiology is diverse but often related to fluid therapy and sodium-containing medicaments. We aim to outline the evidence base on hypernatremia in adult hospitalised patients. METHODS We will conduct a scoping review and adhere to the preferred reporting items for systematic and meta-analysis extension for scoping reviews (PRISMA-ScR). We will systematically search the Cochrane Library, Medline, Pubmed, and Embase from inception with no limitations to language, and include all study designs. We will use the population, exposure, comparator, and outcome-based approach to define eligibility criteria. The population: adult hospitalised patients; exposure: hypernatremia; comparator: no hypernatremia or all types of treatments of hypernatremia; and outcomes: all reported outcomes. Two authors will independently screen and select studies followed by full-text assessment and data extraction in duplicate. All outcome measures will be reported, and descriptive analyses will be performed. The certainty of evidence will be assessed according to an adapted grading of recommendations assessment, development, and evaluation (GRADE) approach. DISCUSSION This scoping review will provide an overview of the current evidence regarding the incidence of hypernatremia, treatment modalities, and outcomes reported for hospitalised adult patients with hypernatremia.
Collapse
Affiliation(s)
- Sine Wichmann
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Rasmus Rønhøj
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Karen L Ellekjær
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten H Bestle
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Kollu K, Bas A, Gok F, Kizilarslanoglu MC. Effect of fosfomycin-induced hypernatremia on patients' hospital stay length and survival. Ir J Med Sci 2024; 193:2453-2459. [PMID: 38767810 DOI: 10.1007/s11845-024-03718-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND AND OBJECTIVE Hypernatremia is a possible side effect of intravenous fosfomycin. The aim of this study was to investigate the effects of changes in sodium (Na) levels on hospital stay and survival in patients hospitalized in the intensive care unit receiving fosfomycin. SUBJECTS AND METHODS This study was conducted retrospectively on the files of patients over the age of 60, who were admitted to the Internal Medicine Intensive Care Unit. Plasma sodium levels were observed and documented over a period of 14 days. The patients were divided into two groups (Hypernatremia group Na > 145 mEq/L vs normonatremia group 135-145 mEq/L). In addition, daily sodium changes were noted for 14 days in patients. RESULTS The mean age of the patients was 75 years. Hospitalization days were longer for hypernatremia patients (31.5 days vs 41 days, p = 0.003). Patients with hypernatremia had an extended duration of stay in the intensive care unit. (21 days vs 31 days p = 0.002). The 1-month survival rate was 61.4% in patients with hypernatremia and 24.9% in patients without hypernatremia (p = 0.004). The absence of hypernatremia increases mortality by 2.09 times (95% CI 1.35-3.23). When discharge and mortality rates were analyzed according to sodium fluctuation, discharged patients exhibited a lower sodium fluctuation (4 min/max (-10/19) vs 6 min/max (-16/32) p < 0.001). CONCLUSION In conclusion, the strength of our study is that it specifically focuses on the consequences of the sodium fluctuation on patient management and provides results.
Collapse
Affiliation(s)
- Korhan Kollu
- Division of Intensive Care, Department of Internal Medicine, Konya City Hospital, University of Health Sciences, Akabe, Adana Çevre Yolu Cd. No:135/1, 42020 Karatay, Konya, Turkey.
| | - Arife Bas
- Department of Internal Medicine, Konya City Hospital, University of Health Sciences, Konya, Turkey
| | - Funda Gok
- Department of Critical Care Medicine, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Muhammet Cemal Kizilarslanoglu
- Division of Geriatrics, Department of Internal Medicine, Konya City Hospital, University of Health Sciences, Konya, Turkey
| |
Collapse
|
3
|
Eraslan Doganay G, Doganci M, Yurtseven G, Ozanbarci A, Kahraman A, Cirik MO, Ozturk Yalcin F, Hazer S, Ensarioglu K. Dysnatremia as a Mortality Marker in Intensive Care Patients with SARS-CoV-2 Infection: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1019. [PMID: 39064448 PMCID: PMC11278994 DOI: 10.3390/medicina60071019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection may cause acute respiratory failure, but also remains responsible for many other pathologies, including electrolyte disorders. SARS-CoV-2 infection causes disorders in many systems and can disrupt water homeostasis with thirst and appetite abnormalities. Dysnatremia affects prognosis, and may be associated with mortality in patients admitted to an intensive care unit (ICU) diagnosed with SARS-CoV-2. Materials and Methods: The study included 209 patients admitted to the ICU between 12 April 2021 and 1 March 2022 who were over 18 years old and diagnosed with SARS-CoV-2 infection by clinical and thoracic tomography findings or with a positive reverse transcription polymerase chain reaction (RT-PCR) test result. The laboratory markers, treatment modalities, nutritional, and respiratory support also for outcome evaluation, length of stay in the ICU, total hospitalization duration, and mortality in the ICU were recorded. The laboratory marker comparison was made using admission with the final assessment performed before the time of mortality in the ICU or after discharge. Results: Inotropic requirements among patients were high, which reflected mortality in the ICU. Hypernatremia presence was associated with an increase in enteral support, the inotropic support requirement, and mortality. Hypernatremia was correlated with diabetes mellitus, chronic renal failure, and a longer duration under mechanical ventilation. Conclusions: Hypernatremia was an important risk factor in ICU patients hospitalized for SARS-CoV-2 infection, which was also affected by the treatment regimens given themselves. This complex relationship underlies the importance of proper electrolyte management, especially in patients who were under severe stress and organ failure.
Collapse
Affiliation(s)
- Guler Eraslan Doganay
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (M.D.); (G.Y.); (M.O.C.); (F.O.Y.)
| | - Melek Doganci
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (M.D.); (G.Y.); (M.O.C.); (F.O.Y.)
| | - Gulsah Yurtseven
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (M.D.); (G.Y.); (M.O.C.); (F.O.Y.)
| | - Azra Ozanbarci
- Anesthesiology and Reanimation Intensive Care Unit, Ministry of Health Ankara Etlik City Hospital, 06170 Ankara, Turkey; (A.O.); (A.K.)
| | - Abdullah Kahraman
- Anesthesiology and Reanimation Intensive Care Unit, Ministry of Health Ankara Etlik City Hospital, 06170 Ankara, Turkey; (A.O.); (A.K.)
| | - Mustafa Ozgur Cirik
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (M.D.); (G.Y.); (M.O.C.); (F.O.Y.)
| | - Fatma Ozturk Yalcin
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (M.D.); (G.Y.); (M.O.C.); (F.O.Y.)
| | - Seray Hazer
- Department of Thorasic Surgery, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey;
| | - Kerem Ensarioglu
- Department of Pulmonology, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey;
| |
Collapse
|
4
|
Pokhriyal SC, Joshi P, Gupta U, Roy P, Parkash S, Kunwar K, Al-Ghuraibawi MMH, Nagpal S, Yadav R, Panigrahi K. Hypernatremia and Its Rate of Correction: The Evidence So Far. Cureus 2024; 16:e54699. [PMID: 38529429 PMCID: PMC10961935 DOI: 10.7759/cureus.54699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Hypernatremia or high serum sodium levels can have many different causes, including insufficient free water intake, or excess free water losses. The management of hypernatremia focuses on resolving the underlying cause, replenishing free water deficit, and preventing further losses while closely monitoring serum sodium concentration. This systematic review was carried out using medical databases such as PubMed, PubMed Central, and Google Scholar for relevant medical literature. The identified articles were reviewed, eligibility criteria were applied, and seven research articles were identified. The effect of the rate of hypernatremia correction on both short- and long-term outcomes in volume-resuscitated patients was the focus of our search for randomized or observational studies. Based on our analysis of the clinical evidence, we concluded that the present recommendations for treating acute and chronic hypernatremia in resuscitated patients do not stem from high-quality research.
Collapse
Affiliation(s)
| | - Prachi Joshi
- Public Health, Georgia Southern University, Atlanta, USA
| | - Uma Gupta
- Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Pulok Roy
- Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Sunil Parkash
- Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | | | | | - Sagar Nagpal
- Internal Medicine, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| | - Ruchi Yadav
- Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | |
Collapse
|
5
|
Ma Y, Zhang P, Hou M. Association of hypernatremia with mortality in patients with COVID-19: A systematic review and meta-analysis. Immun Inflamm Dis 2023; 11:e1109. [PMID: 38156387 PMCID: PMC10714304 DOI: 10.1002/iid3.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic worldwide has caused varying degrees of severity of lung damage in patients, with acute respiratory distress and death in severe cases. However, this is not directly caused by the virus itself, but by the production of inflammasome by monocytes in the body, leading to a systemic inflammatory response, which results in a very poor clinical prognosis for patients with COVID-19. OBJECTIVE The purpose of this meta-analysis was to look at the relationship between hypernatremia and mortality in COVID-19 patients. METHODS We searched the PubMed, Web of Science, Embase, and Cochrane databases for articles published from the inception of the database until August 27, 2022. Three researchers reviewed the literature, retrieved data, and assessed the quality of the literature, respectively. A meta-analysis was performed using State 17 software to assess the value of the effect of hypernatremia on mortality in patients with new coronavirus pneumonia. RESULTS A total of nine publications was finally included in this study, including a total of 11,801 patients with COVID-19, including 1278 in the hypernatremia group and 10,523 in the normonatremia group. Meta-analysis showed that hypernatremia was associated with mortality in patients with COVID-19 [OR = 4.15, 95% CI (2.95-5.84), p = .002, I² = 66.7%] with a sensitivity of 0.36 [0.26, 0.48] and a specificity of 0.88 [0.83, 0.91]. The posterior probability of mortality was 42% in patients with COVID-19 hypernatremia and 15% in patients who did not have COVID-19 hypernatremia. CONCLUSION According to available data, hypernatremia is associated with death in patients with COVID-19.
Collapse
Affiliation(s)
- Yongzhi Ma
- Qinghai University Affiliated HospitalXiningChina
| | | | - Ming Hou
- Qinghai University Affiliated HospitalXiningChina
| |
Collapse
|
6
|
Suzuki R, Uchino S, Sasabuchi Y, Kawarai Lefor A, Shiotsuka J, Sanui M. Enteral free water vs. parenteral dextrose 5% in water for the treatment of hypernatremia in the intensive care unit: a retrospective cohort study from a mixed ICU. J Anesth 2023; 37:868-879. [PMID: 37638970 DOI: 10.1007/s00540-023-03246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Effective treatment options for patients with hypernatremia are limited. Free water administration (parenterally or enterally) is the mainstay of treatment but the impact of each strategy on lowering serum sodium (Na) is not known. The purpose of the study was thus to assess the effectiveness of enteral free water vs. parenteral dextrose 5% in water (D5W) in treating ICU-acquired hypernatremia. METHODS An electronic medical record-based, retrospective cohort study was conducted in a 30-bed mixed medical-surgical intensive care unit (ICU) in Japan. All adult patients admitted to the ICU from August 2017 to July 2021 were reviewed. After a 2-step exclusion, patients who stayed in the ICU ≥ 24 h and received either or both treatments for ICU-acquired hypernatremia (Na ≥ 145 mEq/L) constituted the study cohort. The primary outcome was a change in serum Na during the 24 h before treatment each day (ΔNa); the secondary outcomes were gastrointestinal complications, serum glucose levels, ICU/hospital mortality, ICU/hospital length of stay, and the duration of mechanical ventilation. Repeated measurements on each patient were addressed using a generalized estimated equation (GEE) for multiple linear regression analysis. Analysis was conducted with R version 4.0.3. RESULTS In total, 256/6596 (131: D5W, 125: enteral free water) patients were analyzed. Median treatment lasted 6 days [3-17] for the D5W group vs 7 days [3-14] for the enteral free water group with a total median daily treatment volume of 799 [IQR 299-1221] mL vs. 400 [IQR 262-573] mL. GEE multiple linear regression analysis showed an estimated mean ΔNa per liter of treatment fluid of - 2.25 [95% CI - 2.76 to - 1.74] mEq/L per liter of parenteral D5W vs. - 1.91 mEq decrease [95% CI - 2.75 to - 1.07] per liter of enteral free water. Hydrochlorothiazide was the only medication associated with a statistically significant negative ΔNa by- 0.89 [- 1.57 to - 0.21] mEq/L. There were no significant inter-group differences for secondary outcomes. CONCLUSIONS These results suggest that both enteral free water and parenteral D5W are effective for treating ICU-acquired hypernatremia. Parenteral D5W was slightly more effective than enteral free water to lower serum Na levels in patients with ICU-acquired hypernatremia. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Reina Suzuki
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-Cho, Omiya-Ward, Saitama, 330-0834, Japan.
| | - Shigehiko Uchino
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-Cho, Omiya-Ward, Saitama, 330-0834, Japan
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, Shimotsuke, Japan
| | | | - Junji Shiotsuka
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-Cho, Omiya-Ward, Saitama, 330-0834, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-Cho, Omiya-Ward, Saitama, 330-0834, Japan
| |
Collapse
|
7
|
Förch A, Deetjen P, Heller AR. [Dysnatremia]. DIE ANAESTHESIOLOGIE 2023; 72:293-306. [PMID: 36995370 DOI: 10.1007/s00101-023-01273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/31/2023]
Abstract
Changes in serum sodium concentrations are frequently encountered by anesthesiologists, are complex and are often inadequately treated. Feared consequences include neurological complications, such as cerebral hemorrhage, cerebral edema and coma. Dysnatremia is always accompanied disturbances in the water balance. Accordingly, these are routinely classified based on the tonicity; however, in the daily routine and especially in the acute setting, the volume status and extracellular volume are often difficult to assess. Severe symptomatic hyponatremia with impending cerebral edema is treated by administration of hypertonic saline solution. If the rise in serum sodium is too rapid, there is a risk of central pontine myelinolysis. In a second step, the cause of the hyponatremia can be investigated and the appropriate treatment can be initiated. In the case of hypernatremia, the etiology of the disorder must be clarified before treatment. The goal is to compensate for the water deficiency by correcting the cause, specific volume therapy and, if necessary, drug support. A slow and controlled compensation must be closely monitored in order to avoid neurological complications. An algorithm has been developed that provides an overview of the dysnatremias, aids with making the diagnosis and gives recommendations for treatment measures in the clinical routine.
Collapse
Affiliation(s)
- Anna Förch
- Klinik für Anästhesie und Operative Intensivmedizin, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - Phillip Deetjen
- Klinik für Anästhesie und Operative Intensivmedizin, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Axel R Heller
- Klinik für Anästhesie und Operative Intensivmedizin, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| |
Collapse
|
8
|
Catabolism highly influences ICU-acquired hypernatremia in a mainly trauma and surgical cohort. J Crit Care 2023; 76:154282. [PMID: 36857855 DOI: 10.1016/j.jcrc.2023.154282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE To further analyse causes and effects of ICU-acquired hypernatremia. METHODS This retrospective, single-centre study, analysed 994 patients regarding ICU-acquired hypernatremia. Non-hypernatremic patients (n = 617) were compared to early-hypernatremic (only before ICU-day 4; n = 87), prolonged-hypernatremic (before and after ICU-day 4; n = 169) and late-hypernatremic patients (only after ICU-day 4; n = 121). Trends in glomerular filtration rate (eGFR), urea-to-creatinine ratio (UCR), fraction of urea in total urine osmolality and urine sodium were compared. Risk factors for i) the development of hypernatremia and ii) mortality were determined. RESULTS Thirty-eight percent (n = 377) developed ICU-acquired hypernatremia. Specifically in the prolonged- and late-group, decreased eGFRs and urine sodium but increased UCR and fractions of urea in urine osmolality were present. Decreased eGFR was a risk factor for the development of hypernatremia in all groups; disease severity and increased catabolism particularly in the prolonged- and late-hypernatremic group. Increased age, SAPS-III and signs of catabolism but not the development of hypernatremia itself was identified as significant risk factor for mortality. CONCLUSIONS Late- and prolonged-hypernatremia is highly related to an increased protein metabolism. Besides excessive catabolism, initial disease severity and a decrease in renal function must be considered when confronted with ICU-acquired hypernatremia.
Collapse
|
9
|
Blair PW, Mehta R, Oppong CK, Tin S, Ko E, Tsalik EL, Chenoweth J, Rozo M, Adams N, Beckett C, Woods CW, Striegel DA, Salvador MG, Brandsma J, McKean L, Mahle RE, Hulsey WR, Krishnan S, Prouty M, Letizia A, Fox A, Faix D, Lawler JV, Duplessis C, Gregory MG, Vantha T, Owusu-Ofori AK, Ansong D, Oduro G, Schully KL, Clark DV. Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study. BMJ Open 2023; 13:e067840. [PMID: 36806137 PMCID: PMC9944645 DOI: 10.1136/bmjopen-2022-067840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES We evaluated the performance of commonly used sepsis screening tools across prospective sepsis cohorts in the USA, Cambodia and Ghana. DESIGN Prospective cohort studies. SETTING AND PARTICIPANTS From 2014 to 2021, participants with two or more SIRS (Systemic Inflammatory Response Syndrome) criteria and suspected infection were enrolled in emergency departments and medical wards at hospitals in Cambodia and Ghana and hospitalised participants with suspected infection were enrolled in the USA. Cox proportional hazards regression was performed, and Harrell's C-statistic calculated to determine 28-day mortality prediction performance of the quick Sequential Organ Failure Assessment (qSOFA) score ≥2, SIRS score ≥3, National Early Warning Score (NEWS) ≥5, Modified Early Warning Score (MEWS) ≥5 or Universal Vital Assessment (UVA) score ≥2. Screening tools were compared with baseline risk (age and sex) with the Wald test. RESULTS The cohorts included 567 participants (42.9% women) including 187 participants from Kumasi, Ghana, 200 participants from Takeo, Cambodia and 180 participants from Durham, North Carolina in the USA. The pooled mortality was 16.4% at 28 days. The mortality prediction accuracy increased from baseline risk with the MEWS (C-statistic: 0.63, 95% CI 0.58 to 0.68; p=0.002), NEWS (C-statistic: 0.68; 95% CI 0.64 to 0.73; p<0.001), qSOFA (C-statistic: 0.70, 95% CI 0.64 to 0.75; p<0.001), UVA score (C-statistic: 0.73, 95% CI 0.69 to 0.78; p<0.001), but not with SIRS (0.60; 95% CI 0.54 to 0.65; p=0.13). Within individual cohorts, only the UVA score in Ghana performed better than baseline risk (C-statistic: 0.77; 95% CI 0.71 to 0.83; p<0.001). CONCLUSIONS Among the cohorts, MEWS, NEWS, qSOFA and UVA scores performed better than baseline risk, largely driven by accuracy improvements in Ghana, while SIRS scores did not improve prognostication accuracy. Prognostication scores should be validated within the target population prior to clinical use.
Collapse
Affiliation(s)
- Paul W Blair
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Rittal Mehta
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | | | - Som Tin
- Takeo Provincial Referral Hospital, Takeo, Cambodia
| | - Emily Ko
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Ephraim L Tsalik
- Duke University School of Medicine, Durham, North Carolina, USA
- Danaher Diagnostics, Washington, D.C, USA
| | - Josh Chenoweth
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Michelle Rozo
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Nehkonti Adams
- Naval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland, USA
| | - Charmagne Beckett
- Naval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland, USA
| | - Christopher W Woods
- Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Deborah A Striegel
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Mark G Salvador
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Joost Brandsma
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Lauren McKean
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Rachael E Mahle
- Duke University School of Medicine, Durham, North Carolina, USA
| | - William R Hulsey
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Subramaniam Krishnan
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Michael Prouty
- US Naval Medical Research Unit No 2, Phnom Penh, Cambodia
| | - Andrew Letizia
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | - Anne Fox
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | - Dennis Faix
- US Naval Medical Research Unit No 2, Phnom Penh, Cambodia
| | - James V Lawler
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Chris Duplessis
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Frederick, Maryland, USA
| | - Michael G Gregory
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Frederick, Maryland, USA
| | - Te Vantha
- Takeo Provincial Referral Hospital, Takeo, Cambodia
| | | | - Daniel Ansong
- Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Kevin L Schully
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Danielle V Clark
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| |
Collapse
|
10
|
Shrestha AB, Sapkota UH, Shrestha S, Aryal M, Chand S, Thapa S, Chowdhury F, Salman A, Shrestha S, Shah S, Jaiswal V. Association of hypernatremia with outcomes of COVID-19 patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32535. [PMID: 36595846 PMCID: PMC9794240 DOI: 10.1097/md.0000000000032535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to assess the association of hypernatremia with the outcomes of COVID-19 patients. METHODS We performed a systematic literature search on PubMed, Google Scholar, and Science Direct until October 2021 and found a total of 131 papers. With meticulous screening finally, 17 papers met the inclusion criteria. COVID-19 patients with sodium levels greater than the reference level were the study population and the outcome of interest was the poor outcome; such as mortality, mechanical ventilation, intensive care unit (ICU) admission, and prolonged hospital stay. The pooled estimate was calculated as the odds ratio (OR). RESULTS There were 19,032 patients with hypernatremia in the 17 studies included. An overall random effect meta-analysis showed that hypernatremia was associated with mortality (OR: 3.18 [1.61, 6.28], P < .0001, I2 = 91.99%), prolong hospitalization (OR: 1.97 [1.37, 2.83], P < .001, I2 = 0.00%) and Ventilation (OR: 5.40 [1.89, 15.42], P < .001, I2 = 77.35%), ICU admission (OR: 3.99 [0.89, 17.78], P = .07, I2 = 86.79%). Meta-regression analysis showed the association of age with the ICU outcome of hypernatremia patients. Whereas, other parameters like male, hypertension, chronic kidney disease, and diabetes mellitus did not significantly influence the odds ratio. CONCLUSION Hypernatremia was markedly associated with poor outcomes in patients with COVID-19. Hence, a blood ionogram is warranted and special attention must be given to hypernatremia COVID-19 patients.
Collapse
Affiliation(s)
- Abhigan Babu Shrestha
- M Abdur Rahim Medical College, Dinajpur, Bangladesh
- * Correspondence: Abhigan Babu Shrestha, M Abdur Rahim Medical College, Dinajpur, Bangladesh (e-mail: )
| | | | | | - Manjil Aryal
- M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | | | - Sangharsha Thapa
- Department of Neurology, Jacobs School of Biomedical Sciences, University of Buffalo, Buffalo
| | | | | | - Shumneva Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sangam Shah
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | |
Collapse
|
11
|
de Morais DG, Sanches TRC, Santinho MAR, Yada EY, Segura GC, Lowe D, Navarro G, Seabra VF, Taniguchi LU, Malbouisson LMS, de André CDS, Andrade L, Rodrigues CE. Urinary sodium excretion is low prior to acute kidney injury in patients in the intensive care unit. FRONTIERS IN NEPHROLOGY 2022; 2:929743. [PMID: 37675036 PMCID: PMC10479577 DOI: 10.3389/fneph.2022.929743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/31/2022] [Indexed: 09/08/2023]
Abstract
Background The incidence of acute kidney injury (AKI) is high in intensive care units (ICUs), and a better understanding of AKI is needed. Early chronic kidney disease is associated with urinary concentration inability and AKI recovery with increased urinary solutes in humans. Whether the inability of the kidneys to concentrate urine and excrete solutes at appropriate levels could occur prior to the diagnosis of AKI is still uncertain, and the associated mechanisms have not been studied. Methods In this single-center prospective observational study, high AKI risk in ICU patients was followed up for 7 days or until ICU discharge. They were grouped as "AKI" or "No AKI" according to their AKI status throughout admission. We collected daily urine samples to measure solute concentrations and osmolality. Data were analyzed 1 day before AKI, or from the first to the fifth day of admission in the "No AKI" group. We used logistic regression models to evaluate the influence of the variables on future AKI diagnosis. The expression of kidney transporters in urine was evaluated by Western blotting. Results We identified 29 patients as "No AKI" and 23 patients as "AKI," the latter being mostly low severity AKI. Urinary sodium excretion was lower in "AKI" patients prior to AKI diagnosis, particularly in septic patients. The expression of Na+/H+ exchanger (NHE3), a urinary sodium transporter, was higher in "AKI" patients. Conclusions Urinary sodium excretion is low before an AKI episode in ICU patients, and high expressions of proximal tubule sodium transporters might contribute to this.
Collapse
Affiliation(s)
- David Gomes de Morais
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Talita Rojas Cunha Sanches
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mirela Aparecida Rodrigues Santinho
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Yuki Yada
- Centro de Estatística Aplicada, Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, Brazil
| | - Gabriela Cardoso Segura
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Diogo Lowe
- Centro de Estatística Aplicada, Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme Navarro
- Centro de Estatística Aplicada, Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, Brazil
| | - Victor Faria Seabra
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Leandro Utino Taniguchi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carmen Diva Saldiva de André
- Centro de Estatística Aplicada, Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, Brazil
| | - Lúcia Andrade
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Camila Eleuterio Rodrigues
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
12
|
Severino P, D’Amato A, Prosperi S, Myftari V, Labbro Francia A, Önkaya M, Notari C, Papisca I, Canuti ES, Yarden Revivo M, Birtolo LI, Celli P, Galardo G, Maestrini V, d’Ettorre G, Mancone M, Fedele F. The Mutual Relationship among Cardiovascular Diseases and COVID-19: Focus on Micronutrients Imbalance. Nutrients 2022; 14:3439. [PMID: 36014944 PMCID: PMC9416353 DOI: 10.3390/nu14163439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 12/16/2022] Open
Abstract
Micronutrients are ions and vitamins humbly required by the human body. They play a main role in several physiological mechanisms and their imbalance is strongly associated with potentially-fatal complications. Micronutrient imbalance is associated with many cardiovascular diseases, such as arrythmias, heart failure, and ischemic heart disease. It has been also observed in coronavirus disease 2019 (COVID-19), particularly in most severe patients. The relationship between cardiovascular diseases and COVID-19 is mutual: the latter triggers cardiovascular disease onset and worsening while patients with previous cardiovascular disease may develop a more severe form of COVID-19. In addition to the well-known pathophysiological mechanisms binding COVID-19 and cardiovascular diseases together, increasing importance is being given to the impact of micronutrient alterations, often present during COVID-19 and able to affect the balance responsible for a good functioning of the cardiovascular system. In particular, hypokalemia, hypomagnesemia, hyponatremia, and hypocalcemia are strongly associated with worse outcome, while vitamin A and D deficiency are associated with thromboembolic events in COVID-19. Thus, considering how frequent the cardiovascular involvement is in patients with COVID-19, and how it majorly affects their prognosis, this manuscript provides a comprehensive review on the role of micronutrient imbalance in the interconnection between COVID-19 and cardiovascular diseases.
Collapse
Affiliation(s)
- Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Andrea D’Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Aurora Labbro Francia
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Merve Önkaya
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Claudia Notari
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Ilaria Papisca
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Elena Sofia Canuti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Mia Yarden Revivo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Paola Celli
- Anesthesiology and Intensive Care Unit, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Gioacchino Galardo
- Medical Emergency Unit, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| |
Collapse
|
13
|
Liu D, Mowrey W, Fisher M, Basalely A, McCarthy J, Kumar N, Thakkar J, Azzi Y, Brogan M, Golestaneh L, Reidy KJ, Chen W. Associations of Dysnatremia with COVID-19 Status and Mortality. KIDNEY360 2022; 3:1323-1331. [PMID: 36176656 PMCID: PMC9416846 DOI: 10.34067/kid.0001062022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/20/2022] [Indexed: 01/21/2023]
Abstract
Background In patients without COVID-19, dysnatremia is associated with mortality. These relationships are not well established in patients with COVID-19. We tested the hypotheses that patients with COVID-19 were more likely to have dysnatremia than those without COVID-19 and that, among those with COVID-19, dysnatremia is associated with mortality. Methods We conducted a retrospective observational study of patients admitted to a tertiary care center in the Bronx, New York, during the COVID-19 surge from March 11 to April 26, 2020. Using multinomial logistic regression models, we compared the prevalence of hypernatremia (serum sodium ≥150 mEq/L) and hyponatremia (serum sodium <130 mEq/L) on admission between patients with and without COVID-19. Among patients with COVID-19, we used Cox proportional hazards models to examine the association of dysnatremia with mortality. Results Compared with those without COVID-19 (n=1265), patients with COVID-19 (n=3345) had a higher prevalence of hypernatremia (7% versus 4%, P<0.001) and hyponatremia (7% versus 6%, P=0.04). In adjusted models, COVID-19-positive patients had a higher likelihood of having hypernatremia (adjusted odds ratio=1.87, 95% CI, 1.3 to 2.57, P=0.001) compared with COVID-19-negative patients, whereas the association between hyponatremia and COVID-19 status was no longer significant (P=0.06). Among patients with COVID-19, 775 (23%) died after a median follow-up of 17 days (IQR 7-27 days). Among nonsurvivors, 15% had hypernatremia and 8% had hyponatremia on admission. Hypernatremia was associated with a higher risk of mortality (adjusted hazard ratio=1.28, 95% CI, 1.01 to 1.63, P=0.04) compared with patients with eunatremia. Conclusions In patients hospitalized during the spring 2020 COVID-19 surge, COVID-19 status was associated with hypernatremia on admission. Among patients with COVID-19, hypernatremia was associated with higher mortality. Hypernatremia may be a potential prognostic marker for mortality in COVID-19 patients.
Collapse
Affiliation(s)
- Diane Liu
- Division of Pediatric Nephrology, Weill Cornell Medical Center, New York, New York,Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Bronx, New York
| | - Wenzhu Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Molly Fisher
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Abby Basalely
- Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Bronx, New York,Division of Pediatric Nephrology, Cohen Children’s Medical Center, New Hyde Park, New York
| | - John McCarthy
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
| | - Neelja Kumar
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Jyotsana Thakkar
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Yorg Azzi
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Maureen Brogan
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Ladan Golestaneh
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Kimberly J Reidy
- Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Bronx, New York
| | - Wei Chen
- Division of Nephrology, Montefiore Medical Center, Bronx, New York,Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York,Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| |
Collapse
|
14
|
Mapata L, Richards GA, Laher AE. Hypernatremia at a Tertiary Hospital Intensive Care Unit in South Africa. Cureus 2022; 14:e22648. [PMID: 35371787 PMCID: PMC8962634 DOI: 10.7759/cureus.22648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Hypernatremia in the critical care setting is a major cause of morbidity and mortality. However, data pertaining to this has not been evaluated in South African hospitals. The aim of this study was to evaluate hypernatremia with regards to its prevalence, associated factors, and outcomes at an academic hospital intensive care unit (ICU) in Johannesburg, South Africa. Methods The ICU charts of patients admitted to the Charlotte Maxeke Johannesburg Academic Hospital adult general ICU from June 1, 2016 to May 31, 2017 were retrospectively reviewed. Subjects were categorized into three groups namely, ICU-acquired hypernatremia (IAH), pre-admission hypernatremia (PAH), and normonatremia. Data was compared between the three groups. Results Of the 833 subjects that were enrolled, 310 (37.2%) were hypernatremic. IAH was present in 144 (17.2%) and PAH in 166 (19.9%) subjects. Hypernatremia was significantly (p <0.05) associated with a higher rate of altered mental status, higher Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) scores, a higher rate and duration of mechanical ventilation, a greater need for inotropic/vasopressor support, longer ICU stay and higher ICU mortality. Conclusion Hypernatremia in ICU patients remains a significant contributor to morbidity, mortality, and ICU length of stay. The prevalence of hypernatremia was much higher than that reported in higher-income countries.
Collapse
|
15
|
Chávez-Íñiguez JS, Maggiani-Aguilera P, Rondon-Berrios H, Kashani KB, Pérez-Flores C, Michel-González J, De la Torre-Quiroga AE, Luna-Ramos A, Navarro-Blackaller G, Romero-Muñoz A, Martínez-Navarro AT, Chávez-Alonso G, Medina-González R, García-García G. Serum sodium trajectory during AKI and mortality risk. J Nephrol 2022; 35:697-701. [DOI: 10.1007/s40620-021-01225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022]
|
16
|
Longhitano E, Nardi C, Calabrese V, Messina R, Mazzeo G, Venanzi Rullo E, Ceccarelli M, Chatrenet A, Saulnier P, Torreggiani M, Nunnari G, Piccoli GB, Santoro D. Hypernatraemia and low eGFR at hospitalization in COVID-19 patients: a deadly combination. Clin Kidney J 2021; 14:2227-2233. [PMID: 34603699 PMCID: PMC8394821 DOI: 10.1093/ckj/sfab122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the general population and the burden of pre-existing comorbidities has heavily affected the outcome of the infection. Hyponatraemia has been frequently described. Conversely, hypernatraemia has rarely been described in COVID-19. Methods The studied cohort encompasses all COVID-19 patients consecutively admitted to the Messina Hospital, Italy, during the first wave of the epidemic. Since healthcare structures were not overwhelmed at that time, indications for hospitalization were homogeneous throughout the study period. Serum sodium levels, kidney function [estimated glomerular filtration rate (eGFR)], demographic and clinical characteristics were recorded at admission. Correlation between mortality, sodium and eGFR was evaluated by survival curves and univariate and multivariate regression models. Results Baseline biochemical and clinical data at the time of admission were available for 115 COVID-19-confirmed patients. The median age at admission was 73 years (48% men), with a median Charlson Comorbidity Index of 4. A total of 23.5% of patients presented with a sodium level ≥146 mmol/L, while 7.8% had sodium <135 mmol/L. Hypernatraemic patients were older, with higher comorbidity. Age, hypernatraemia and reduced eGFR were associated with increased mortality in both univariate and multivariate regression models (P < 0.001). The combination of hypernatraemia and reduced renal function at admission had an odds ratio of 47.67 (95% confidence interval 10.08–225.43) of dying compared with patients with an eGFR ≥60 mL/min and sodium <145 mmol/L. Conclusions Our study suggests that the association between hypernatraemia and reduced eGFR at referral is a highly relevant prognostic marker for death during hospitalization. The role of this association should be further tested in larger, multicentre cohorts.
Collapse
Affiliation(s)
- Elisa Longhitano
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Chiara Nardi
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Vincenzo Calabrese
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Roberta Messina
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Giuliana Mazzeo
- Section of Anesthesiology, Department of Human Pathology of Adult and Childhood 'G Barresi', A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Antoine Chatrenet
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France.,Laboratory 'Movement, Interactions, Performance' (EA 4334), Le Mans University, Le Mans, France
| | - Patrick Saulnier
- Département de Biostatistiques et Méthodologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | - Giuseppe Nunnari
- Section of Anesthesiology, Department of Human Pathology of Adult and Childhood 'G Barresi', A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Giorgina Barbara Piccoli
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France.,Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| |
Collapse
|
17
|
Schilling J, Compton F, Schmidt-Ott K. [Hypo- and hypernatremia in the intensive care unit : Pitfalls in volume management]. Med Klin Intensivmed Notfmed 2021; 116:672-677. [PMID: 34599374 DOI: 10.1007/s00063-021-00873-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
Hypo- and hypernatremias are very frequent in intensive care unit (ICU) patients and are closely related to volume disturbances and volume management in the ICU. They are associated with longer ICU stays and significant increases in mortality. Treating them is more complex than it may initially appear. Hyponatremias are differentiated based on tonicity and volume status. With hypertonic and isotonic hyponatremias, the primary focus of treatment is the underlying hyperglycemia. In case of hypotonic hypovolemic hyponatremia, the condition is treated with balanced crystalloid solutions. In eu-/hypervolemic hypotonic hyponatremias acute treatment with hypertonic saline is necessary. Hypervolemic hypernatremia occurs almost exclusively in ICU patients, often due to infusion of hypertonic solutions. There is little evidence to guide treatment, although hypotonic infusions in conjunction with diuretics may represent a legitimate approach. Great emphasis should be placed on prevention and the infusion of hypertonic solutions should be avoided. Disturbances in plasma sodium concentrations are common, requiring close attention. Exact diagnostic classification needs to be made and volume managed accordingly.
Collapse
Affiliation(s)
- Johannes Schilling
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - Friederike Compton
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Kai Schmidt-Ott
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| |
Collapse
|
18
|
Rugg C, Bachler M, Mösenbacher S, Wiewiora E, Schmid S, Kreutziger J, Ströhle M. Early ICU-acquired hypernatraemia is associated with injury severity and preceded by reduced renal sodium and chloride excretion in polytrauma patients. J Crit Care 2021; 65:9-17. [PMID: 34052781 DOI: 10.1016/j.jcrc.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To further elucidate the origin of early ICU-acquired hypernatraemia. MATERIAL AND METHODS In this retrospective single-centre study, polytrauma patients requiring ICU treatment were analysed. RESULTS Forty-eight (47.5%) of 101 included polytrauma patients developed hypernatraemia within the first 7 days on ICU. They were more severely ill as described by higher SAPS III, ISS, daily SOFA scores and initial norepinephrine requirements as well as longer requirements of mechanical ventilation and ICU treatment in general. The development of hypernatraemia was neither attributable to fluid- or sodium-balances nor renal impairment. Although lower in the hypernatraemic group from day 4 onwards, median creatinine clearances were sufficiently high throughout the observation period. However, in the hypernatraemic group, urine sodium and chloride concentrations prior to the evolvement of hypernatraemia (56 (27-87) mmol/l and 39 (23-77) mmol/l) were significantly decreased when compared to i) the time after developing hypernatraemia (94 (58-134) mmol/l and 78 (36-115) mmol/l; p < 0.001) and ii) the non-hypernatraemic group in general (101 (66-143) mmol/l and 75 (47-109) mmol/l; p < 0.001). CONCLUSIONS Early ICU-acquired hypernatraemia is associated with injury severity and preceded by reduced renal sodium and chloride excretion in polytrauma patients.
Collapse
Affiliation(s)
- Christopher Rugg
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Mirjam Bachler
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Simon Mösenbacher
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Elena Wiewiora
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Stefan Schmid
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Janett Kreutziger
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Mathias Ströhle
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| |
Collapse
|