Plasma sodium concentration in older patients as an indicator of severity in emergencies: Results from the Emergency Department and Elder Needs-16 study.

Autor:	Llorens P; Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España., Miró Ò; Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España., Veguillas Benito M; Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España., Fernández C; Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España., Jacob J; Servicio de Urgencias, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Barcelona, España., Burillo-Putze G; Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España. Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, España., Alquézar A; Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España., Aguiló S; Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España., Puiggali Ballard M; Servicio de Urgencias, Hospital del Mar, Barcelona, España., Bretones Baena S; Servicio de Urgencias, Hospital Reina Sofía, Córdoba, España., Hong Cho JU; Servicio de Urgencias, Hospital de Mendaro, Guipuzcoa, España., San Julián Romero M; Servicio de Urgencias, Hospital Universitario Gregorio Marañón, Madrid, España., Rodríguez Palma ME; Servicio de Urgencias, Hospital Universitario de Burgos, España., Álvarez Madrigal A; Servicio de Urgencias, Complejo Asistencial Universitario de León, España., Rodríguez Romero M; Servicio de Urgencias, Hospital Universitario Morales Meseguer, Murcia, España., Lozano López MI; Servicio de Urgencias, Hospital Francecs de Borja de Gandía, España., González González R; Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, España., Carrión Fernández M; Servicio de Urgencias, Hospital Universitario Virgen Arrixaca, Murcia, España., Morales Franco B; Servicio de Urgencias, Hospital Universitario Lorenzo Guirao, Cieza, España., Poch Ferrer EA; Servicio de Urgencias, Hospital Josep Trueta, Girona, España., González Guillén V; Servicio de Urgencias, Hospital Miguel Servet, Zaragoza, España., Gayoso Martín S; Servicio de Urgencias, Hospital Comarcal El Escorial, Madrid, España., Sánchez Sindín G; Servicio de Urgencias, Hospital Do Salnes, Villagarcía de Arosa, España., Prieto Zapico A; Servicio de Urgencias, Hospital de Barbanza, Ribeira, A Coruña, España., Ponte Márquez P; Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España., Espinosa B; Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España., González del Castillo J; Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España.
Jazyk:	English; Spanish; Castilian
Zdroj:	Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias [Emergencias] 2023 Aug; Vol. 35 (4), pp. 279-287.
DOI:	10.55633/s3me/E043.2023
Abstrakt:	Objectives: To study baseline factors associated with hypo- and hypernatremia in older patients attended in emergency departments (EDs) and explore the association between these dysnatremias and indicators of severity in an emergency. Material and Methods: We included patients attended in 52 Spanish hospital EDs aged 65 years or older during a designated week. All included patients had to have a plasma sodium concentration on record. Patients were distributed in 3 groups according to sodium levels: normal, 135-145 mmol/L; hyponatremia, 135 mmol/L; or hypernatremia > 145 mmol/L. We analyzed associations between sodium concentration and 24 variables (sociodemographic information, measures of comorbidity and baseline functional status, and ongoing treatment for hypo- or hypernatremia). Indicators of the severity in emergencies were need for hospitalization, in-hospital mortality, prolonged ED stay (> 12 hours) in discharged patients, and prolonged hospital stay (> 7 days) in admitted patients. We used restricted cubic spline curves to analyze the associations between sodium concentration and severity indicators, using 140 mmol/L as the reference. Results: A total of 13 368 patients were included. Hyponatremia was diagnosed in 13.5% and hypernatremia in 2.9%. Hyponatremia was associated with age ($ 80 years), hypertension, diabetes mellitus, an active neoplasm, chronic liver disease, dementia, chemotherapy, and needing help to walk. Hypernatremia was associated with needing help to walk and dementia. The percentages of cases with severity indicators were as follows: hospital admission, 40.8%; in-hospital mortality, 4.3%; prolonged ED stay, 15.9%; and prolonged hospital stay, 49.8%. Odds ratios revealed associations between lower sodium concentration cut points in patients with hyponatremia and increasing need for hospitalization (130 mmol/L, 2.24 [IC 95%, 2.00-2.52]; 120 mmol/L, 4.13 [3.08-5.56]; and 110 mmol/L, 7.61 [4.53-12.8]); risk for in-hospital death (130 mmol/L, 3.07 [2.40-3.92]; 120 mmol/L, 6.34 [4.22- 9.53]; and 110 mmol/L, 13.1 [6.53-26.3]); and risk for prolonged ED stay (130 mmol/L, 1.59 [1.30-1.95]; 120 mmol/L, 2.77 [1.69-4.56]; and 110 mmol/L, 4.83 [2.03-11.5]). Higher sodium levels in patients with hypernatremia were associated with increasing need for hospitalization (150 mmol/L, 1.94 [1.61-2.34]; 160 mmol/L, 4.45 [2.88-6.87]; 170 mmol/L, 10.2 [5.1-20.3]; and 180 mmol/L, 23.3 [9.03-60.3]); risk for in-hospital death (150 mmol/L, 2.77 [2.16-3.55]; 160 mmol/L, 6.33 [4.11-9.75]; 170 mmol/L, 14.5 [7.45-28.1]; and 180 mmol/L, 33.1 [13.3-82.3]); and risk for prolonged ED stay (150 mmol/L, 2.03 [1.48-2.79]; 160 mmol/L, 4.23 [2.03-8.84]; 170 mmol/L, 8.83 [2.74-28.4]; and 180 mmol/L, 18.4 [3.69-91.7]). We found no association between either type of dysnatremia and prolonged hospital stay. Conclusion: Measurement of sodium plasma concentration in older patients in the ED can identify hypo- and hypernatremia, which are associated with higher risk for hospitalization, death, and prolonged ED stays regardless of the condition that gave rise to the dysnatremia.
Databáze:	MEDLINE
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