• Takahiro Kinoshita, Eric Mlodzinski, Qian Xiao, Raphael Sherak, Nathan H Raines, and Leo A Celi.
• Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
• J Crit Care. 2023 Oct 1; 77: 154325154325.

PurposeLimited evidence exists regarding outcomes associated with different correction rates of severe hyponatremia.Materials And MethodsThis retrospective cohort analysis employed a multi-center ICU database to identify patients with sodium ≤120 mEq/L during ICU admission. We determined correction rates over the first 24 h and categorized them as rapid (> 8 mEq/L/day) or slow (≤ 8 mEq/L/day). The primary outcome was in-hospital mortality. Secondary outcomes included hospital-free days, ICU-free days, and neurological complications. We used inverse probability weighting for confounder adjustment.ResultsOur cohort included 1024 patients; 451 rapid and 573 slow correctors. Rapid correction was associated with lower in-hospital mortality (absolute difference: -4.37%; 95% CI, -8.47 to -0.26%), longer hospital-free days (1.80 days; 95% CI, 0.82 to 2.79 days), and longer ICU-free days (1.16 days; 95% CI, 0.15 to 2.17 days). There was no significant difference in neurological complications (2.31%; 95% CI, -0.77 to 5.40%).ConclusionRapid correction (>8 mEq/L/day) of severe hyponatremia within the first 24 h was associated with lower in-hospital mortality and longer ICU and hospital-free days without an increase in neurological complication. Despite major limitations, including the inability to identify the chronicity of hyponatremia, the results have important implications and warrant prospective studies.Copyright © 2023 Elsevier Inc. All rights reserved.

12 keywords...

hide…