Impact of hyponatremia and the syndrome of inappropriate antidiuresis on mortality in elderly patients with aspiration pneumonia

Jun Miyashita, Toshihiko Shimada, Alan Hunter, Toru Kamiya

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND:Hyponatremia is associated with pneumonia, and aspiration pneumonia is common in the elderly, however, there has been no study of hyponatremia in this population. OBJECTIVE: To determine the impact of hyponatremia on mortality in elderly patients with aspiration pneumonia, while focusing on the comparison between those with and without the syndrome of inappropriate antidiuresis (SIAD). DESIGN: Retrospective review of existing database and medical records. SETTING: A community teaching hospital in Japan. PATIENTS: Two hundred and twenty-one elderly patients hospitalized with aspiration pneumonia. MEASUREMENTS: Multivariate logistical regression models were used to compare 30-day and in-hospital mortality, in patients with hyponatremia of various severities and etiologies, with that in patients with normal serum sodium concentrations. RESULTS: Sixty-five (29%) of 221 patients had hyponatremia. Of these 62 (95%) had hypotonic hyponatremia, which were further assessed as having hypovolemic (39 [63%]), hypervolemic (3 [5%]), and euvolemic (20 [32%]) hyponatremia. Of the 20 euvolemic patients, 14 (70%) had SIAD. Both moderate and severe hypotonic hyponatremia were significantly associated with increased in-hospital mortality (odds ratio [OR] 6.05, 95% confidence interval [CI] 1.46-25.0, and OR 5.65, 95% CI 1.14-28.1, respectively). Hyponatremia due to SIAD was significantly associated with both increased 30-day mortality (OR 7.40, 95% CI 1.73-31.7) and increased in-hospital mortality (OR 22.3, 95% CI 4.26-117). In contrast, hypovolemic hyponatremia was not significantly associated with increased mortality. CONCLUSIONS: Hyponatremia due to SIAD was strongly associated with increased mortality in elderly patients with aspiration pneumonia, whereas hypovolemic hyponatremia was not associated with increased mortality. Journal of Hospital Medicine 2012;

Original languageEnglish (US)
Pages (from-to)464-469
Number of pages6
JournalJournal of Hospital Medicine
Volume7
Issue number6
DOIs
StatePublished - Jul 2012

Fingerprint

Aspiration Pneumonia
Hyponatremia
Mortality
Hypovolemia
Hospital Mortality
Odds Ratio
Confidence Intervals
Hospital Medicine
Community Hospital
Teaching Hospitals
Medical Records
Pneumonia
Japan

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

Cite this

Impact of hyponatremia and the syndrome of inappropriate antidiuresis on mortality in elderly patients with aspiration pneumonia. / Miyashita, Jun; Shimada, Toshihiko; Hunter, Alan; Kamiya, Toru.

In: Journal of Hospital Medicine, Vol. 7, No. 6, 07.2012, p. 464-469.

Research output: Contribution to journalArticle

@article{ab87d7613c89479baef916cd86c600e9,
title = "Impact of hyponatremia and the syndrome of inappropriate antidiuresis on mortality in elderly patients with aspiration pneumonia",
abstract = "BACKGROUND:Hyponatremia is associated with pneumonia, and aspiration pneumonia is common in the elderly, however, there has been no study of hyponatremia in this population. OBJECTIVE: To determine the impact of hyponatremia on mortality in elderly patients with aspiration pneumonia, while focusing on the comparison between those with and without the syndrome of inappropriate antidiuresis (SIAD). DESIGN: Retrospective review of existing database and medical records. SETTING: A community teaching hospital in Japan. PATIENTS: Two hundred and twenty-one elderly patients hospitalized with aspiration pneumonia. MEASUREMENTS: Multivariate logistical regression models were used to compare 30-day and in-hospital mortality, in patients with hyponatremia of various severities and etiologies, with that in patients with normal serum sodium concentrations. RESULTS: Sixty-five (29{\%}) of 221 patients had hyponatremia. Of these 62 (95{\%}) had hypotonic hyponatremia, which were further assessed as having hypovolemic (39 [63{\%}]), hypervolemic (3 [5{\%}]), and euvolemic (20 [32{\%}]) hyponatremia. Of the 20 euvolemic patients, 14 (70{\%}) had SIAD. Both moderate and severe hypotonic hyponatremia were significantly associated with increased in-hospital mortality (odds ratio [OR] 6.05, 95{\%} confidence interval [CI] 1.46-25.0, and OR 5.65, 95{\%} CI 1.14-28.1, respectively). Hyponatremia due to SIAD was significantly associated with both increased 30-day mortality (OR 7.40, 95{\%} CI 1.73-31.7) and increased in-hospital mortality (OR 22.3, 95{\%} CI 4.26-117). In contrast, hypovolemic hyponatremia was not significantly associated with increased mortality. CONCLUSIONS: Hyponatremia due to SIAD was strongly associated with increased mortality in elderly patients with aspiration pneumonia, whereas hypovolemic hyponatremia was not associated with increased mortality. Journal of Hospital Medicine 2012;",
author = "Jun Miyashita and Toshihiko Shimada and Alan Hunter and Toru Kamiya",
year = "2012",
month = "7",
doi = "10.1002/jhm.1936",
language = "English (US)",
volume = "7",
pages = "464--469",
journal = "Journal of hospital medicine (Online)",
issn = "1553-5606",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

TY - JOUR

T1 - Impact of hyponatremia and the syndrome of inappropriate antidiuresis on mortality in elderly patients with aspiration pneumonia

AU - Miyashita, Jun

AU - Shimada, Toshihiko

AU - Hunter, Alan

AU - Kamiya, Toru

PY - 2012/7

Y1 - 2012/7

N2 - BACKGROUND:Hyponatremia is associated with pneumonia, and aspiration pneumonia is common in the elderly, however, there has been no study of hyponatremia in this population. OBJECTIVE: To determine the impact of hyponatremia on mortality in elderly patients with aspiration pneumonia, while focusing on the comparison between those with and without the syndrome of inappropriate antidiuresis (SIAD). DESIGN: Retrospective review of existing database and medical records. SETTING: A community teaching hospital in Japan. PATIENTS: Two hundred and twenty-one elderly patients hospitalized with aspiration pneumonia. MEASUREMENTS: Multivariate logistical regression models were used to compare 30-day and in-hospital mortality, in patients with hyponatremia of various severities and etiologies, with that in patients with normal serum sodium concentrations. RESULTS: Sixty-five (29%) of 221 patients had hyponatremia. Of these 62 (95%) had hypotonic hyponatremia, which were further assessed as having hypovolemic (39 [63%]), hypervolemic (3 [5%]), and euvolemic (20 [32%]) hyponatremia. Of the 20 euvolemic patients, 14 (70%) had SIAD. Both moderate and severe hypotonic hyponatremia were significantly associated with increased in-hospital mortality (odds ratio [OR] 6.05, 95% confidence interval [CI] 1.46-25.0, and OR 5.65, 95% CI 1.14-28.1, respectively). Hyponatremia due to SIAD was significantly associated with both increased 30-day mortality (OR 7.40, 95% CI 1.73-31.7) and increased in-hospital mortality (OR 22.3, 95% CI 4.26-117). In contrast, hypovolemic hyponatremia was not significantly associated with increased mortality. CONCLUSIONS: Hyponatremia due to SIAD was strongly associated with increased mortality in elderly patients with aspiration pneumonia, whereas hypovolemic hyponatremia was not associated with increased mortality. Journal of Hospital Medicine 2012;

AB - BACKGROUND:Hyponatremia is associated with pneumonia, and aspiration pneumonia is common in the elderly, however, there has been no study of hyponatremia in this population. OBJECTIVE: To determine the impact of hyponatremia on mortality in elderly patients with aspiration pneumonia, while focusing on the comparison between those with and without the syndrome of inappropriate antidiuresis (SIAD). DESIGN: Retrospective review of existing database and medical records. SETTING: A community teaching hospital in Japan. PATIENTS: Two hundred and twenty-one elderly patients hospitalized with aspiration pneumonia. MEASUREMENTS: Multivariate logistical regression models were used to compare 30-day and in-hospital mortality, in patients with hyponatremia of various severities and etiologies, with that in patients with normal serum sodium concentrations. RESULTS: Sixty-five (29%) of 221 patients had hyponatremia. Of these 62 (95%) had hypotonic hyponatremia, which were further assessed as having hypovolemic (39 [63%]), hypervolemic (3 [5%]), and euvolemic (20 [32%]) hyponatremia. Of the 20 euvolemic patients, 14 (70%) had SIAD. Both moderate and severe hypotonic hyponatremia were significantly associated with increased in-hospital mortality (odds ratio [OR] 6.05, 95% confidence interval [CI] 1.46-25.0, and OR 5.65, 95% CI 1.14-28.1, respectively). Hyponatremia due to SIAD was significantly associated with both increased 30-day mortality (OR 7.40, 95% CI 1.73-31.7) and increased in-hospital mortality (OR 22.3, 95% CI 4.26-117). In contrast, hypovolemic hyponatremia was not significantly associated with increased mortality. CONCLUSIONS: Hyponatremia due to SIAD was strongly associated with increased mortality in elderly patients with aspiration pneumonia, whereas hypovolemic hyponatremia was not associated with increased mortality. Journal of Hospital Medicine 2012;

UR - http://www.scopus.com/inward/record.url?scp=84864776777&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84864776777&partnerID=8YFLogxK

U2 - 10.1002/jhm.1936

DO - 10.1002/jhm.1936

M3 - Article

VL - 7

SP - 464

EP - 469

JO - Journal of hospital medicine (Online)

JF - Journal of hospital medicine (Online)

SN - 1553-5606

IS - 6

ER -