Abstract
Objectives: Plasma osmolarity is a common marker used for evaluating the balance of fluid and electrolyte in clinical practice, and it has been proven to be related to prognosis of many diseases. The purpose of this study was to identify the association between plasma osmolarity and in-hospital mortality in cardiac intensive care unit (CICU) patients.Method: All of the patients were divided into seven groups stratified by plasma osmolarity, and the group with 290–300 mmol/L osmolarity was used as a reference group. Primary outcome was in-hospital mortality. The local weighted regression (Lowess) smoothing curve was drawn to determine the “U”-shaped relationship between plasma osmolarity and in-hospital mortality. Binary logistic regression analysis was performed to determine the effect of plasma osmolarity on the risk of in-hospital mortality.Result: Overall, 7,060 CICU patients were enrolled. A “U”-shaped relationship between plasma osmolarity and in-hospital mortality was observed using the Lowess smoothing curve. The lowest in-hospital mortality (7.2%) was observed in the reference group. whereas hyposmolarity (<280 mmol/L vs. 290–300 mmol/L: 13.0 vs. 7.2%) and hyperosmolarity (≥330 mmol/L vs. 290–300 mmol/L: 31.6 vs. 7.2%) had higher in-hospital mortality. After adjusting for possible confounding variables with binary logistic regression analysis, both hyposmolarity (<280 mmol/L vs. 290–300 mmol/L: OR, 95% CI: 1.76, 1.08–2.85, P = 0.023) and hyperosmolarity (≥330 mmol/L vs. 290–300 mmol/L: OR, 95% CI: 1.65, 1.08–2.52, P = 0.021) were independently associated with an increased risk of in-hospital mortality. Moreover, lengths of CICU and hospital stays were prolonged in patients with hyposmolarity or hyperosmolarity.Conclusion: A “U”-shaped relationship between plasma osmolarity and in-hospital mortality was observed. Both hyposmolarity and hyperosmolarity were independently associated with the increased risk of in-hospital mortality.
Highlights
The prognosis of cardiovascular diseases has greatly improved due to technological advances and innovative drug use, cardiovascular diseases still remain the leading cause of death and disability worldwide [1]
A “U”-shaped relationship between plasma osmolarity and in-hospital mortality was observed. Both hyposmolarity and hyperosmolarity were independently associated with the increased risk of in-hospital mortality
We usually consider 285–307 mmol/L as a normal range of plasma osmolarity [8]; according to the local weighted regression (Lowess) smoothing curve (Figure 2), we found that in-hospital mortality was the lowest when plasma osmolarity ranged from 290 to 300 mmol/L
Summary
The prognosis of cardiovascular diseases has greatly improved due to technological advances and innovative drug use, cardiovascular diseases still remain the leading cause of death and disability worldwide [1]. Previous clinical studies have shown that plasma osmolarity is associated with prognosis of many diseases, such as stroke [9], intracerebral hemorrhage [10], and gastrointestinal diseases [11]. In patients with coronary artery disease undergoing percutaneous coronary intervention (PCI), higher plasma osmolarity was shown to be associated with higher mortality and acute kidney injury [14, 15]. Plasma osmolarity is closely associated with the severity of disease, in-hospital mortality, and other adverse outcomes in critically ill patients [11]. No research has been done to explore the influence of plasma osmolarity on the prognosis of CICU patients. The purpose of this study was to identify the association between plasma osmolarity and inhospital mortality in CICU patients
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