title: The syndrome of inappropriate antidiuretic hormone secretion: Distribution and characterization according to etiologies.
abstract: OBJECTIVE
  To determine the distribution of etiologies for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in hospitalized patients and to characterize patients according to the different etiologies.
  
  
  METHODS
  A single-center retrospective study including all patients diagnosed with SIADH in a large community hospital and tertiary center between 1.1.2007 and 1.1.2013. Two physicians reviewed every patient's medical file for predetermined relevant clinical data.
  
  
  RESULTS
  The study cohort included 555 patients. The most common etiologies were malignancies and medication-induced SIADH, followed by idiopathic SIADH, pulmonary infections, pain and nausea, and central nervous system (CNS) disorders. Subgroup analysis according to etiology showed that CNS disorders were associated with more severe episodes of SIADH. Patients with idiopathic SIADH were older than patients with a specific diagnosis, had a lower urine osmolality, and required less treatment with hypertonic saline. Long-term survival was determined primarily by SIADH etiology rather than hyponatremia severity, with hazard ratios for death of up to 7.31 (95% CI 4.93-10.82, p<0.001) for patients with malignancy-associated SIADH as compared to patients with idiopathic SIADH. Hyponatremia grade at short-term follow-up was also predictive for long-term survival (HR 1.42 per grade, 95% CI 1.21-1.66, p<0.001).
  
  
  CONCLUSIONS
  Patients with SIADH have different characteristics and a different prognosis according to SIADH etiology. Serum sodium concentration at short-term follow-up is predictive of long-term survival. These findings might have diagnostic and treatment-related implications.
authors.affiliation: Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: Shepshelovich@yahoo.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shepshelovich
authors.affiliation: Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Chiya
authors.initials: C
authors.lastname: Leibovitch
authors.affiliation: Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Alina
authors.initials: A
authors.lastname: Klein
authors.affiliation: Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Shirit
authors.initials: S
authors.lastname: Zoldan
authors.affiliation: Department of Nephrology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Gai
authors.initials: G
authors.lastname: Milo
authors.affiliation: Statistical Consulting Unit, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Tzippy
authors.initials: T
authors.lastname: Shochat
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel.
authors.forename: Benaya
authors.initials: B
authors.lastname: Rozen-zvi
authors.affiliation: Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Lahav
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002493:Central Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D007177:Inappropriate ADH Syndrome / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D007557:Israel; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D010146:Pain / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D012462:Saline Solution, Hypertonic
keywords: Characterization; Distribution; Etiology; SIADH