HCPLive Network

Hyponatremia Associated with Worse Outcomes Following Cardiac Surgery

To study the association between postoperative hyponatremia and mortality, length of hospital stay (LOS), and complications, the authors of “Postoperative Hyponatremia Predicts an Increase in Mortality and In-Hospital Complications after Cardiac Surgery,” published in Journal of the American College of Surgeons, studied outcomes from 4,850 patients who underwent cardiac surgery.
They found that 59% of patients experienced postoperative hyponatremia. These patients tended to have lower left ventricle ejection fraction, higher mean pulmonary artery pressures, lower glomerular filtration rate, higher EuroSCORE, and were more likely to be New York Heart Association class IV.
Hyponatremic patients in the study also had a higher prevalence of COPD, and peripheral vascular disease.
Patients with hyponatremia experienced increased overall and late mortality rates, with mortality rates increasing with the severity of the hyponatremia.
They also spent more time in the hospital (average length of stay of 11 days vs. 7 days for non-hyponatremic patients).
The authors reported that, after adjusting for baseline and procedure variables, “postoperative hyponatremia was associated with increase in mortality (hazard ratio 1.22, 95% CI 1.06–1.4, p = 0.004), LOS (multiplier 1.34, 95% CI 1.22–1.49, p < 0.001), infectious (odds ratio [OR] 2.32, 95% CI 1.48–3.62, p < 0.001), pulmonary (OR 1.82, 95% CI 1.49–2.21, p < 0.001), and renal failure complications (OR 2.46, 95% CI 1.58–3.81, p < 0.001) and need for dialysis (OR 3.66, 95% CI 1.72–7.79, p = 0.001).
Based on these results, the author concluded that “hyponatremia is common after cardiac surgery and is an independent predictor of increased mortality, length of hospital stay, and postoperative complications.”

Further Reading
Study results show that eluxadoline may be useful in patients with diarrhea-predominant irritable bowel syndrome (IBS-D) who do not achieve symptom relief with loperamide.
Study results show significant regional variations in the types of procedures and tests administered and the number of prescriptions written for patients with irritable bowel syndrome (IBS), as well as in the number of emergency department visits and hospital admissions.
John Saltzman, MD, Discusses the gastrointestinal tract and its part in the functioning of the body.
Type 2 diabetes occurs at roughly the same prevalence in men and women. Despite the similar prevalence in the sexes, women who develop diabetes feel the effect of its complications disproportionately.
Research presented at the European League Against Rheumatism’s Annual Meeting indicates comorbid diabetes may be linked to increased osteoarthritis pain.
Analysis of a dozen phase III trials indicates that patients with atrial fibrillation face significantly less risk of major, fatal, and intracranial bleeding if they take target-specific oral anticoagulants rather than vitamin K antagonists.
Calculation and interpretation of the anion gap is extremely useful in the evaluation and treatment of the patient with metabolic acidosis. In this installment, we look at case examples involving patients with multiple sclerosis and urosepsis; COPD, diabetes, and renal failure; and type 1 diabetes.
More Reading