• Eur. J. Intern. Med. · May 2020

    Randomized Controlled Trial

    Mild to moderate hyponatremia at discharge is associated with increased risk of recurrence in patients with community-acquired pneumonia.

    • Laura Potasso, Clara Odilia Sailer, Claudine Angela Blum, Nicole Cesana-Nigro, Philipp Schuetz, Beat Mueller, and Mirjam Christ-Crain.
    • Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland. Electronic address: laura.potasso@usb.ch.
    • Eur. J. Intern. Med. 2020 May 1; 75: 44-49.

    BackgroundHyponatremia is the most common electrolyte disorder in hospitalized patients with pneumonia. Different studies have shown an association of hyponatremia on admission and worse patient's outcome. Yet, the impact of hyponatremia at discharge or of hyponatremia correction on patient's prognosis is unknown.MethodsThis is a preplanned secondary data analysis from a double-blind, randomized, placebo-controlled trial of hospitalized patients with community-acquired pneumonia and prednisone treatment. The primary outcome was the impact of hyponatremia on admission and at discharge on patient relevant outcomes (i.e. mortality, rehospitalization and recurrence rate) within 180 days.ResultsOf the 708 included patients, 185 (26.1%) were hyponatremic on admission. Of these, 28 (15.1%) were still hyponatremic at discharge. 34 (4.8%) patients developed hyponatremia during hospitalization despite being normonatremic on admission. Patients with hyponatremia at discharge had a higher rate of pneumonia recurrence as compared to normonatremic patients (OR 2.68; 95%-CI 1.09-6.95; p = 0.037). Among patients with hyponatremia at discharge, patients who were already hyponatremic on admission showed the strongest association with increased recurrence rate (OR 4.01; 95%-CI 1.08-12.64; p = 0.022). In contrast, recurrence rate was not affected in patients who were hyponatremic on admission but had normalized serum sodium levels at discharge (p = 0.73).ConclusionMild to moderate hyponatremia at discharge is associated with an increased risk of recurrence in hospitalized patients with pneumonia. This association is particularly strong for patients who are hyponatremic both on admission and at discharge, emphasizing the importance of hyponatremia correction during hospitalization.Copyright © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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