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Influence of Early Dysnatremia Correction on Survival of Critically Ill Patients

Darmon, Michael*†; Pichon, Matthias*†; Schwebel, Carole‡§; Ruckly, Stéphane‡§; Adrie, Christophe; Haouache, Hakim; Azoulay, Elie**; Bouadma, Lila††; Clec’h, Christophe‡‡; Garrouste-Orgeas, Maït駧; Souweine, Bertrand∥∥; Goldgran-Toledano, Dany¶¶; Khallel, Hatem***; Argaud, Laurent†††‡‡‡; Dumenil, Anne-Sylvie§§§; Jamali, Samir∥∥∥; Allaouchiche, Bernard****; Zeni, Fabrice*†; Timsit, Jean-François‡§

doi: 10.1097/SHK.0000000000000135
Clinical Aspects

ABSTRACT Increasing evidence suggests that dysnatremia at intensive care unit (ICU) admission may predict mortality. Little information is available, however, on the potential effect of dysnatremia correction. This is an observational multicenter cohort study in patients admitted between 2005 and 2012 to 18 French ICUs. Hyponatremia and hypernatremia were defined as serum sodium concentration less than 135 and more than 145 mmol/L, respectively. We assessed the influence on day 28 mortality of dysnatremia correction by day 3 and of the dysnatremia correction rate. Of 7,067 included patients, 1,830 (25.9%) had hyponatremia and 634 (9.0%) had hypernatremia at ICU admission (day 1). By day 3, hyponatremia had been corrected in 1,019 (1,019/1,830; 55.7%) and hypernatremia in 393 (393/634; 62.0%) patients. After adjustment for confounders, persistent hyponatremia or hypernatremia on day 3 was independently associated with higher day 28 mortality (odds ratio [OR], 1.31; 95% confidence interval [95% CI], 1.06 – 1.61; and OR, 1.86; 95% CI, 1.37 – 2.54; respectively). Hyponatremia corrected by day 3, hypernatremia corrected by day 3, and ICU-acquired hyponatremia were not associated with day 28 mortality. Median correction rate from days 1 to 3 was 2.58 mmol/L per day (interquartile range, 0.67 – 4.55). Higher natremia correction rate was associated with lower crude and adjusted day 28 mortality rates (OR per mmol/L per day, 0.97; 95% CI, 0.94 – 1.00; P = 0.04; and OR per mmol/L per day, 0.93; 95% CI, 0.90 – 0.97; P = 0.0003, respectively). Our results indicate that dysnatremia correction is independently associated with survival, with the effect being greater with faster correction rates of up to 12 mmol/L per day.

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*Medical Intensive Care Unit, Saint-Etienne University Hospital, Avenue Albert Raymond, Saint-Priest en Jarez; Jacques Lisfranc Medical School, Saint-Etienne University, Saint-Etienne; University of Grenoble 1 (Joseph Fourier) Integrated Research Center, Albert Bonniot Institute, and §Polyvalent Intensive Care Unit, Grenoble University Hospital, Grenoble; Department of Physiology, Cochin University Hospital, Paris; Surgical Intensive Care Unit, Mondor University Hospital, Créteil; **Medical Intensive Care Unit, University Hospital St Louis; and ††Medical Intensive Care Unit, Bichat University Hospital, Paris; ‡‡Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Bobigny; §§Polyvalent Intensive Care Unit, Groupe Hospitalier St Joseph, Paris; ∥∥Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont Ferrand; ¶¶Polyvalent Intensive Care Unit, Gonesse General Hospital, Gonesse; ***Intensive Care Unit, Centre Hospitalier Andrée Rosemon, Cayenne; †††Medical Intensive Care Unit, Hospices Civils de Lyon, Edouard Herriot University Hospital; and ‡‡‡Lyon University, Lyon-Est Medical School, Lyon; §§§Surgical Intensive Care Unit, Antoine Béclère University Hospital, Clamart; ∥∥∥Polyvalent Intensive Care Unit, Centre Hospitalier Sud Essonne Dourdan-Etampes-Siège, Etampes; and ****Surgical Intensive Care Unit, Edouard Herriot University Hospital, Hospices Civiles de Lyon, Lyon, France

Received 14 Oct 2013; first review completed 7 Nov 2013; accepted in final form 6 Jan 2014

Address reprint requests to Michael Darmon, MD, Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Avenue Albert Raimond, 42270 Saint-Priest-en-Jarez, France. E-mail: michael.darmon@chu-st-etienne.fr.

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