title: The association between sodium fluctuations and mortality in surgical patients requiring intensive care.
abstract: Serum sodium derangement is the most common electrolyte disturbance among patients admitted to intensive care. This study aims to validate the association between dysnatremia and serum sodium fluctuation with mortality in surgical intensive care patients.
  
  
  
  We performed a retrospective analysis of the Medical Information Mart for Intensive Care II database. Dysnatremia was defined as a sodium concentration outside physiologic range (135-145mmol/L) and subjects were categorized by severity of dysnatremia and sodium fluctuation. Univariate and multivariable logistic regressions were used to test for associations between sodium fluctuations and mortality.
  
  
  
  We identified 8600 subjects, 39% of whom were female, with a median age of 66years for analysis. Subjects with dysnatremia were more likely to be dead at 28 days (17% vs 7%; P<.001). There was a significant association between sodium fluctuation and mortality at 28 days (adjusted odds ratio per 1mmol/L change, 1.10 [95% confidence interval, 1.08-1.12; P<.001]), even in patients who remained normotremic during their intensive care unit stay (1.12 [95% confidence interval, 1.09-1.16; P<.001]) CONCLUSIONS: This observational study validates previous findings of an association between serum sodium fluctuations and mortality in surgical intensive care patients. This association was also present in subjects who remained normonatremic throughout their intensive care unit admission.
authors.affiliation: Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK. Electronic address: dominic.marshall@medsci.ox.ac.uk.
authors.forename: Dominic C
authors.initials: DC
authors.lastname: Marshall
authors.affiliation: Academic Foundation Program, Northeast Thames Foundation School, London, UK; Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Salciccioli
authors.affiliation: Imperial College School of Medicine, Imperial College London, London, UK.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Goodson
authors.affiliation: Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Pimentel
authors.affiliation: Imperial College School of Medicine, Imperial College London, London, UK.
authors.forename: Kristi Y
authors.initials: KY
authors.lastname: Sun
authors.affiliation: Beth Israel Deaconess Medical Centre, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, MA.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
authors.affiliation: Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4 North, Charing Cross Hospital, London, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shalhoub
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D016208:Databases, Factual; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011184:Postoperative Period; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood*; D013222:State Medicine; D013514:Surgical Procedures, Operative / Q000401:mortality*; D014883:Water-Electrolyte Imbalance / Q000097:blood / Q000401:mortality*
chemical_list: D012964:Sodium
keywords: Dysnatremia; Electrolyte disturbances; Mortality; Sodium; Surgery