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Abstract: TH-OR073

Increased Short-Term and Long-Term Mortality in Community- and Hospital-Acquired Hypernatremia and in Patients with Delayed Sodium Correction

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Thongprayoon, Charat, Mayo Clinic, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Qian, Qi, Mayo Clinic, Rochester, Minnesota, United States
Background

This study examined short- and long-term mortality (i) in a large cohort of general hospitalized adults with community- and hospital-acquired hypernatremia and (ii) in hypernatremic patients with and without serum [Na+] correction within three days of hospital stay.

Methods

Adult patients admitted to Mayo Clinic Rochester in a three-year (2011-2013) period were examined. Patients were categorized into 3 groups based on serum [Na+] at admission and during hospitalization; 1) normal serum [Na+], 2) community-acquired hypernatremia, and 3) hospital-acquired hypernatremia. Normal serum [Na+] was defined as serum [Na+] at admission and all during hospitalization within 138-142 mEq/L. Community-acquired hypernatremia was defined as serum [Na+] at admission ≥ 143 mEq/L, whereas hospital-acquired hypernatremia was defined as serum [Na+] at admission 138-142 mEq/L but any serum [Na+] during hospitalization ≥ 143 mEq/L. Outcomes included hospital and 1-year mortality

Results

Of the total 25,781 patients, 44.7% (n=11,531) were normonatremic, 20.3% (n=5,229) were community-acquired hypernatremia and 35.0% were hospital acquired hypernatremia. In fully adjusted models, ORs (95% CIs) for hospital mortality and HRs (95% CIs) for one-year mortality were 4.91 (3.47-6.94) and 2.25 (2.01-2.53) for community-acquired and 4.11 (2.94-5.73) and 2.35 (2.12-2.60) for hospital-acquired hypernatremia. Hospital-acquired hypernatremia showed a higher hospital, but not one-year, mortality than community-acquired hypernatremia. Among patients with community-acquired hypernatremia, 36.1% (n=1,893) remained hypernatremic by hospital day three ([Na+] 145±3 mEq/L). Fully adjusted hospital- and one-year mortality were significantly increased in patients without [Na+] correction, 3.01 (2.01-4.49), 1.51 (1.26-1.81), respectively, compared to those with [Na+] correction.

Conclusion

Hypernatremia, regardless of acquisition origin, is associated with elevated short-term and long-term mortality. Hospital-acquired hypernatremia was more common and had a higher short-term mortality than community-acquired hypernatremia. Failure to correct hypernatremia by hospital day three is associated with increased morbidity and mortality.