title: Hypernatremia at Hospital Discharge and Out of Hospital Mortality Following Primary Intracerebral Hemorrhage.
abstract: In patients with intracerebral hemorrhage (ICH), it is not clear if hypernatremia is merely a marker of disease severity or if elevated sodium levels are harmful. We hypothesized that hypernatremia at hospital discharge in primary ICH patients would be associated with increased mortality following discharge.
  
  
  
  We performed a two-center observational study of critically ill ICH patients in Boston. We studied 5100 patients, age ≥18 years, who were diagnosed with ICH (ICD-9 code 431), received medical or surgical critical care between 1997 and 2011 and survived hospitalization. The exposure of interest was serum sodium within 24 h of hospital discharge, categorized as Na ≤ 145 mmol/L and Na > 145 mmol/L. The primary outcome was 30-day post-discharge mortality. Odds ratios were estimated by logistic regression models adjusted for age, race, gender, Deyo-Charlson Index, patient type (medical versus surgical) and sepsis.
  
  
  
  In ICH patients who received critical care and survived hospitalization, the serum sodium at discharge was a predictor of post-discharge mortality. Patients with a discharge Na > 145 mmol/L have an OR for mortality in the 30 days following hospital discharge of 1.82 (95 %CI 1.38-2.38; P < 0.001) and an adjusted OR of 1.87 (95 %CI 1.40-2.48; P < 0.001) both relative to patients with a discharge Na ≤ 145 mmol/L. The adjusted model showed good discrimination AUC 0.77 (95 %CI 0.74-0.79) and calibration (Hosmer-Lemeshow χ (2) P = 0.68).
  
  
  
  In critically ill ICH patients who survive hospitalization, hypernatremia at the time of discharge is a robust predictor of post-discharge mortality.
authors: Department of Neurology, Rush University Medical Center, Chicago, IL, USA.
authors: Torrey
authors: T
authors: Boland
authors: Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
authors: Galen V
authors: GV
authors: Henderson
authors: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors: Fiona K
authors: FK
authors: Gibbons
authors: Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: H Bart
authors: HB
authors: Brouwers
authors: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors: Steven M
authors: SM
authors: Greenberg
authors: Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.
authors: Miriam
authors: M
authors: Raffeld
authors: Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.
authors: Christina E
authors: CE
authors: Kourkoulis
authors: Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.
authors: Jonathan
authors: J
authors: Rosand
authors: The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, MRB 418, Boston, MA, 02115, USA. kbchristopher@partners.org.
authors: Kenneth B
authors: KB
authors: Christopher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D003422:Critical Care; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge
keywords: Critical care; Hypernatremia; Intensive care; Intracerebral hemorrhage; Mortality; Sodium