title: Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change.
abstract: BACKGROUND
  To assess the prevalence of dysnatremia, including borderline changes in serum sodium concentration, and to estimate the impact of these dysnatremia on mortality after adjustment for confounders.
  
  
  METHODS
  Observational study on a prospective database fed by 13 intensive care units (ICUs). Unselected patients with ICU stay longer than 48 h were enrolled over a 14-year period were included in this study. Mild to severe hyponatremia were defined as serum sodium concentration < 135, < 130, and < 125 mmol/L respectively. Mild to severe hypernatremia were defined as serum sodium concentration > 145, > 150, and > 155 mmol/L respectively. Borderline hyponatremia and hypernatremia were defined as serum sodium concentration between 135 and 137 mmol/L or 143 and 145 respectively.
  
  
  RESULTS
  A total of 11,125 patients were included in this study. Among these patients, 3,047 (27.4%) had mild to severe hyponatremia at ICU admission, 2,258 (20.3%) had borderline hyponatremia at ICU admission, 1,078 (9.7%) had borderline hypernatremia and 877 (7.9%) had mild to severe hypernatremia. After adjustment for confounder, both moderate and severe hyponatremia (subdistribution hazard ratio (sHR) 1.82, 95% CI 1.002 to 1.395 and 1.27, 95% CI 1.01 to 1.60 respectively) were associated with day-30 mortality. Similarly, mild, moderate and severe hypernatremia (sHR 1.34, 95% CI 1.14 to 1.57; 1.51, 95% CI 1.15 to 1.99; and 2.64, 95% CI 2.00 to 3.81 respectively) were independently associated with day-30 mortality.
  
  
  CONCLUSIONS
  One-third of critically ill patients had a mild to moderate dysnatremia at ICU admission. Dysnatremia, including mild changes in serum sodium concentration, is an independent risk factor for hospital mortality and should not be neglected.
authors: Michael
authors: M
authors: Darmon
authors: Eric
authors: E
authors: Diconne
authors: Bertrand
authors: B
authors: Souweine
authors: Stéphane
authors: S
authors: Ruckly
authors: Christophe
authors: C
authors: Adrie
authors: Elie
authors: E
authors: Azoulay
authors: Christophe
authors: C
authors: Clec'h
authors: Maïté
authors: M
authors: Garrouste-Orgeas
authors: Carole
authors: C
authors: Schwebel
authors: Dany
authors: D
authors: Goldgran-Toledano
authors: Hatem
authors: H
authors: Khallel
authors: Anne-Sylvie
authors: AS
authors: Dumenil
authors: Samir
authors: S
authors: Jamali
authors: Christine
authors: C
authors: Cheval
authors: Bernard
authors: B
authors: Allaouchiche
authors: Fabrice
authors: F
authors: Zeni
authors: Jean-François
authors: JF
authors: Timsit
mesh_terms: D000368:Aged; D001288:Attention; D015331:Cohort Studies; D016638:Critical Illness / Q000453:epidemiology; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D007010:Hyponatremia / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood*
chemical_list: D012964:Sodium