Premium
Hyponatremia and activation of vasopressin secretion are both independently associated with 30‐day mortality: results of a multicenter, observational study
Author(s) -
Eckart A.,
Hausfater P.,
Amin D.,
Amin A.,
Haubitz S.,
Bernard M.,
Baumgartner A.,
Struja T.,
Kutz A.,
ChristCrain M.,
Huber A.,
Mueller B.,
Schuetz P.
Publication year - 2018
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12764
Subject(s) - medicine , hyponatremia , observational study , vasopressin , multicenter study , secretion , endocrinology , intensive care medicine , randomized controlled trial
Background Hyponatremia is a common feature of acute illness and associated with increased mortality. This may be explained by a stress‐mediated activation of the vasopressin system with an increase in free‐water reabsorption. Objectives To investigate whether the association between hyponatremia and mortality could be explained by activation of the vasopressin system. Methods We prospectively enrolled adult, medical patients seeking emergency care in three centres in Switzerland, France and the United States. We investigated associations between admission plasma sodium and copeptin, a stable portion of the vasopressin‐precursor peptide, with 30‐day mortality. We performed uni‐ and multivariate regression analysis. Results Of 6962 included patients, 18% had hyponatremia (sodium ≤135 mmol L −1 ), which doubled their risk for mortality compared to patients with normonatremia (8.3% vs. 3.8%). This association was confirmed in a multivariate‐adjusted logistic regression analysis [adjusted odds ratio (OR) 1.47, 95% CI 1.12–1.93, P = 0.005]. Vasopressin levels, mirrored by copeptin, were also increased in nonsurvivors and strongly associated with mortality (adjusted OR 3.42, 95% CI 2.76–4.25, P < 0.001). The association between hyponatremia and mortality remained unchanged when adding copeptin levels to the regression model (fully adjusted OR 1.53, 95% CI 1.16–2.00, P = 0.002). Conclusion This prospective study including medical patients upon emergency room admission found hyponatremia as well as an activation of the vasopressin system to be independently associated with mortality. This suggests that stress‐ and vasopressin‐independent mechanisms are responsible for the association of low sodium levels with mortality.