ECE2018 Guided Posters Neuroendocrinology (11 abstracts)
Hyponatremia-associated mortality and volemia in patients on parenteral nutrition: a prospective multicenter study
Ana Ortolá Buigues 1 , Emilia Gómez Hoyos 1 , María Dolores Del Olmo García 2 , Ana Herrero Ruiz 3 , Julia Álvarez Hernández 4 , Cristina Tejera Pérez 5 , Sandra Herranz Antolín 6 , Irene Bretón Lesmes 7 , Miguel Angel Martínez Olmos 8 & Daniel De Luis Román 1
1Hospital Clínico Universitario de Valladolid, Valladolid, Spain; 2Hospital Universitario Severo Ochoa, Leganés, Spain; 3Hospital Universitario de Salamanca, Salamanca, Spain; 4Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain; 5Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain; 6Hospital General Universitario de Guadalajara, Guadalajara, Spain; 7Hospital General Universitario Gregorio Marañón, Madrid, Spain; 8Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
Introduction: In patients receiving Parenteral Nutritcion (PN), hyponatremia is associated with increased in-hospital mortality. Our objective was to evaluate the influence of volemic classification (hypovolemia, euvolemia or hypervolemia) on in-hospital mortality in patients receiving PN presenting hyponatremia.
Methods: Prospective, non-interventional, multicenter study in 19 Spanish hospitals. 543 non-critical patients receiving PN were recruited. Hyponatremia was defined as a Serum sodium level (SNa) < 135 mmol/l. Patient data collected included gender, age, prior comorbidity, body mass index-BMI-, nutritional assessment by subjective global assessment (SGA), SNa at start of and during PN, in-hospital mortality, and type (volemic classification) of hyponatremia. Duration of PN, metabolic and infectious complications related to PN were also registered. Statistics: univariate and multivariate logistic regression.
Results: 60.2% were men. Median age 67 [IQR 57–76]. 162 patients (29.8%) presented hyponatremia. Clinical volemia was evaluated in 137/162: 14.6% were hypovolemic, 67.9% euvolemic, 17.5% hypervolemic. In-hospital mortality was: 13.6% (22.5% of hyponatremic patients vs 9.8% of normonatremic patients; P<0.001). In-hospital mortality according to hyponatremia type was: 20.0% in hypovolemic patients, 20.9% in euvolemic patients, 41.7% in hypervolemic patients (P=0.096). In multivariate logistic regression, hyponatremia was independently associated with increased in-hospital mortality (OR 1.83 [95% CI 1.03–3.24]; P=0.039), following correction for age, gender, SGA, BMI, prior comorbidity, duration of PN and metabolic /infectious complications related to PN. In the same multivariate analysis model, the Odds Ratios for in-hospital mortality by type of hyponatremia as compared with patients with eunatremia were: 1.95 (95% CI 0.54–7.07, P=0.307) in hypovolemia, 1.44 (95% CI 0.69–3.00, P=0.337) in euvolemia, and 3.36 (95% CI 1.17–9.63, P=0.024) in hypervolemia.
Conclusion: Hyponatremia is independently associated with increased in-hospital mortality in patients receiving parenteral nutrition. Patients with hypervolemic hyponatremia present a marked increase in mortality risk as compared with patients presenting eunatremia.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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