Serum sodium level variability as a prognosticator in older adults

Maryam A. Barma (Lead / Corresponding author), Roy L. Soiza, Peter T. Donnan, Mark M. McGilchrist, Helen Frost, Miles D. Witham

Research output: Contribution to journalArticle

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Abstract

Our aim was to explore biological variation of serum sodium levels as a method of quantifying health risk in older adults. We investigated whether dynamic changes in serum sodium levels could provide additional prognostic information to standard predictors of mortality in older people. Analysis of routinely collected clinical datasets containing information on demographics, hospitalisation, biochemistry, haematology and physical function for Dundee in-patient rehabilitation services, between 1999 and 2011. Older people admitted to inpatient rehabilitation following an acute medical or surgical hospitalisation. Five dynamic measures of sodium levels homeostasis–minimum, maximum, standard deviation, and minimum and maximum deviation from mean–were derived for each individual, using biochemistry data from the year preceding their rehabilitation discharge. Cox regression models tested for associations with time to death. Covariates included age, sex, discharge Barthel score, co-morbid diagnoses, haemoglobin, albumin and eGFR. 3021 patients were included (mean age 84 years, 1776 (58.8%) females). 1651 (54.7%) patients experienced hyponatraemia and 446 (14.8%) became hypernatraemic. Mean sodium was correlated with all mean, minimum and SD of sodium. Kaplan–Meier survival curves showed that those without sodium perturbations had the best mortality outcomes, whilst those with both hyponatremia and hypernatremia had the worst. Multivariate Cox regression showed that standard deviation and hypernatraemia were significant predictors of death in non-adjusted models, but not fully adjusted models. All dynamic measures of dysnatraemia were associated with increased mortality risk, but failed to add predictive value to established static measures after adjusting for covariates.

Original languageEnglish
Pages (from-to)632-638
Number of pages7
JournalScandinavian Journal of Clinical and Laboratory Investigation
Volume78
Issue number7-8
DOIs
Publication statusPublished - 3 Jan 2019

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Sodium
Serum
Patient rehabilitation
Hypernatremia
Biochemistry
Rehabilitation
Hyponatremia
Mortality
Hospitalization
Health risks
Hematology
Proportional Hazards Models
Inpatients
Albumins
Hemoglobins
Demography
Survival
Health

Keywords

  • Frail elderly
  • hypernatremia
  • hyponatremia
  • mortality
  • sodium
  • Prognosis
  • Sodium/blood
  • Humans
  • Mortality
  • Risk Factors
  • Kaplan-Meier Estimate
  • Proportional Hazards Models
  • Male
  • Hypernatremia/diagnosis
  • Hyponatremia/diagnosis
  • Aged, 80 and over
  • Female
  • Aged

Cite this

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Serum sodium level variability as a prognosticator in older adults. / Barma, Maryam A. (Lead / Corresponding author); Soiza, Roy L.; Donnan, Peter T.; McGilchrist, Mark M.; Frost, Helen; Witham, Miles D.

In: Scandinavian Journal of Clinical and Laboratory Investigation, Vol. 78, No. 7-8, 03.01.2019, p. 632-638.

Research output: Contribution to journalArticle

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T1 - Serum sodium level variability as a prognosticator in older adults

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AU - Soiza, Roy L.

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