Hyponatremia-Long-Term Prognostic Factor for Nonfatal Pulmonary Embolism.

Anca Ouatu,Madalina Stefana Mihai,Nicoleta Dima,Mariana Floria,Lacramioara Ionela Serban,Cristina Gena Dascalu,Ciprian Rezus,Daniela Maria Tanase

doi:10.3390/diagnostics11020214

Abstract

Over recent years, studies have shown that in patients with left-sided heart failure, arterial hypertension, and acute coronary syndrome, hyponatremia is a negative prognostic factor. In this context, there is raising interest in the association between hyponatremia and pulmonary embolism (PE). This retrospective cohort study includes 404 consecutive patients with confirmed acute nonfatal pulmonary embolism divided into four groups according to their sodium fluctuation pattern. The primary outcome was all-cause mortality and determining the recurrence rate among patients with nonfatal PE using serum sodium levels as a continuous variable. Patients with acquired and persistent hyponatremia had a significantly higher rate of mortality rate than those in the normonatremia group (12.8% and 40.4%, OR- 7.206, CI: 2.383–21.791, p = 0.000 and OR-33.250, CI: 11.521–95.960, p = 0.000 vs. 2%, p < 0.001, respectively). Mean survival time decreases from 23.624 months (95% CI: (23.295–23.953)) in the normonatremia group to 16.426 months (95% CI: (13.17–19.134)) in the persistent hyponatremia group, statistically significant (p = 0.000). The mean survival time for all patients was 22.441 months (95% CI: (21.930–22.951)). The highest recurrence rate was recorded at 12 and 24 months in the acquired hyponatremia group (16.7% and 14.1%, respectively). Serum sodium determination is a simple and cost-effective approach in evaluating the short and long-term prognosis in patients with acute PE.

Highlights

Hyponatremia is the most frequent electrolyte disorder in hospitalized patients (~30%).In-hospital mortality is increased by over 50% in patients with hyponatremia compared with those with normonatremia [1]
Confirmed pulmonary embolism (PE) was diagnosed according to the published guidelines: computed tomography pulmonary angiography (CTPA) positive for PE, ventilation-perfusion lung scintigraphy with a high probability of pulmonary thromboembolism or ventilation-perfusion lung scintigraphy with an intermediate probability associated with the presence of distal deep vein thrombosis on compression ultrasonography
Of the 438 patients that met the criteria for acute PE, 34 patients (7.76%) were excluded from the study because they were lost to follow-up

Summary

Introduction

Hyponatremia is the most frequent electrolyte disorder in hospitalized patients (~30%). In-hospital mortality is increased by over 50% in patients with hyponatremia compared with those with normonatremia [1]. In-hospital mortality and long-term mortality (1 to 5 years) is higher in patients with persistent (6.2%) and acquired hyponatremia (5.9%), compared with those with corrected hyponatremia (3.9%); the lowest mortality rate is recorded in normonatremic patients (1.8%) [2]. The same study reveals that hyponatremic patients have more comorbidities compared with patients with normal sodium levels. Maintaining normal serum sodium levels is crucial for proper cellular activity. Sodium level reflects the intracellular fluid volume but tells us nothing about total

Objectives

Methods

Results

Discussion

Conclusion