Background
Methods
Data source
Study design and definitions
Data extraction
Demographic characteristics and Comorbidities
Statistical analysis
Phenome-wide association analysis
Results
Extraction of the patients data
Study population
Characteristic | Hyponatremia | Normal sodium level | Hypernatremia |
P Value | ||||
---|---|---|---|---|---|---|---|---|
Serum Sodium Levela, mmol/L | <125 (n = 367) | [125;130) (n = 1053) | [130;135) (n = 5045) | [135;145] (n = 38,869) | (145;150] (n = 386) | (150;155] (n = 58) | >155 (n = 51) | |
Age, mean ± SD, years | 71 ± 15 | 68 ± 16 | 66 ± 18 | 60 ± 18 | 66 ± 20 | 70 ± 20 | 73 ± 20 | < .001 |
Males, n (%) | 195 (53.1) | 544 (51.6) | 2916 (57.8) | 23,197 (59.7) | 244 (63.2) | 32 (55.2) | 26 (51.0) | < .001 |
ICU stay, n (%) | 119 (32.4) | 295 (28.0) | 1191 (23.6) | 7531 (19.4) | 177 (45.9) | 32 (55.2) | 20 (39.2) | < .001 |
Palliative care, n (%) | 11 (3.0) | 45 (4.3) | 151 (3.0) | 296 (0.8) | 14 (3.6) | 1 (1.7) | 4 (7.8) | < .001 |
Dialysis, n (%) | 52 (14.2) | 140 (13.3) | 403 (8.0) | 1322 (3.4) | 48 (12.4) | 6 (10.3) | 6 (11.8) | < .001 |
Dementia, n (%) | 14 (3.8) | 32 (3.0) | 131 (2.6) | 640 (1.6) | 7.3 | 8.6 | 17.6 | < .001 |
Hospital admissions via the emergency department, n (%) | 123 (33.5) | 306 (29.1) | 886 (17.6) | 4091 (10.5) | 95 (24.6) | 22 (37.9) | 25 (49.0) | < .001 |
Surgery, n (%) | 64 (17.4) | 241 (22.9) | 1313 (26) | 14,329 (36.9) | 124 (32.1) | 16 (27.6) | 5 (9.8) | < .001 |
Number of diagnosis codes, median (IQR) | 7 (4–11) | 6 (4–10) | 6 (3–9) | 4 (2–6) | 6 (4–10) | 6 (3–10) | 6 (4–10) | < .001 |
Length of stay (days), median (IQR) | 10 (5–18) | 10 (6–19) | 8 (4–16) | 5 (2–10) | 9 (4–21) | 10 (4.25–18.75) | 10 (5–20.5) | < .001 |
Charlson Comorbidity Index median (IQR) | 2 (1–5) | 3 (1–5) | 2 (1–4) | 1 (0–2) | 2 (0.25–3) | 2 (0.25–3.75) | 2 (1–3) | < .001 |
Observed hospital mortality, n (%) | 69 (18.8) | 145 (13.7) | 452 (9.0) | 1066 (2.7) | 80 (20.7) | 14 (24.1) | 12 (23.5) | < .001 |
Characteristic | OR (95%CI) |
P Value |
---|---|---|
Serum sodium concentration, mmol/L | ||
< 125 | 7.95 (5.91–10.53) | <.001 |
[125;130) | 5.59 (4.62–6.72) | <.001 |
[130;135) | 3.58 | <.001 |
[135;145] | 1 [Reference] | |
(145;150] | 9.19 (7.06–11.83) | <.001 |
(150;155] | 10.16 (5.10–18.74) | <.001 |
Age, years | ||
< 30 | 1 [Reference] | NA |
[30;40) | 0.66 (0.45–0.97) | .0381 |
[40;50) | 1.02 (0.74–1.40) | .9256 |
[50;60) | 1.94 (1.49–2.56) | <.001 |
[60;70) | 1.83 (1.42–2.41) | <.001 |
[70;80) | 2.43 (1.88–3.18) | <.001 |
[80;90) | 4.00 (3.11–5.24) | <.001 |
≥ 90 | 6.41 (4.80–8.66) | <.001 |
Sex | ||
F | 1 [Reference] | NA |
M | 1.20 (1.09–1.32) | <.001 |
Duration of hospital stay, days | ||
≤ 7 | 1 [Reference] | NA |
(7;14] | 1.59 (1.41–1.80) | <.001 |
(14;21] | 2.55 (2.19–2.97) | <.001 |
(21;42] | 4.04 (3.50–4.66) | <.001 |
> 42 | 5.81 (4.80–6.98) | <.001 |
Number of ICD-10 codes | ||
≤ 1 | 1 [Reference] | NA |
(1;4] | 1.39 (1.08–1.80) | .0112 |
(4;7] | 3.96 (3.13–5.08) | <.001 |
(7;10] | 7.34 (5.78–9.44) | <.001 |
(10;15] | 10.61 (8.32–13.69) | <.001 |
(15;20] | 18.31 (13.84–24.40) | <.001 |
> 20 | 31.77 (23.50–43.20) | <.001 |
Hospital admissions via the emergency department | 2.29 (2.04–2.56) | <.001 |
Any surgery | 1.04 (0.94–1.15) | .402 |
ICU stay | 11.85 (10.29–12.69) | <.001 |
Palliative care | 12.75 (10.54–15.38) | <.001 |
Dialysis | 15.49 (13.86–17.30) | <.001 |
Dementia | 2.67 (2.11–3.34) | <.001 |
Charlson Comorbidity Index | ||
0 | 1 [Reference] | NA |
1 | 2.72 (2.21–3.36) | <.001 |
2 | 4.56 (3.76–5.54) | <.001 |
3–4 | 7.59 (6.31–9.17) | <.001 |
5–9 | 12.12 (10.11–14.62) | <.001 |
≥ 10 | 19.86 (15.31–25.72) | <.001 |
Phenome-wide association analysis
ICD-10 codes | Association with mortality OR (IC95%) |
P Value | Association with dysnatremia OR (IC95%) |
P Value |
---|---|---|---|---|
Boderline Hyponatremia | ||||
A41 Other sepsis | 4.7 (3.1–6.88) | < 0.001 | 5.83 (4.4–7.69) | < 0.001 |
I20 Angina pectoris | 0.23 (0.13–0.37) | < 0.001 | 0.67 (0.55–0.79) | < 0.001 |
I25 Chronic ischemic heart disease | 0.47 (0.34–0.64) | < 0.001 | 0.53 (0.44–0.62) | < 0.001 |
I48 Atrial fibrillation and flutter | 0.15 (0.07–0.3) | < 0.001 | 0.62 (0.5–0.76) | < 0.001 |
I71 Aortic aneurysm and dissection | 2.37 (1.9–2.92) | < 0.001 | 0.66 (0.53–0.8) | < 0.001 |
J15 Bacterial pneumonia, not elsewhere classified | 2.9 (1.94–4.16) | < 0.001 | 2.75 (2.13–3.51) | < 0.001 |
J80 Acute respiratory distress syndrome | 30.64 (23.27–40.36) | < 0.001 | 3.1 (2.28–4.17) | < 0.001 |
J96 Respiratory failure, not elsewhere classified | 6.14 (5.19–7.22) | < 0.001 | 2.29 (1.98–2.63) | < 0.001 |
K65 Peritonitis | 6.53 (4.46–9.3) | < 0.001 | 3.19 (2.32–4.33) | < 0.001 |
R07 Pain in throat and chest | 0.1 (0.02–0.3) | < 0.001 | 0.35 (0.23 0.5) | < 0.001 |
R57 Shock, not elsewhere classified | 18.73 (15.81–22.16) | < 0.001 | 3.56 (3.01–4.21) | < 0.001 |
Z48 Encounter for other postprocedural aftercare | 0.63 (0.51–0.77) | < 0.001 | 0.62 (0.55–0.7) | < 0.001 |
Z51 Encounter for other aftercare | 2.46 (1.97–3.04) | < 0.001 | 1.95 (1.68–2.25) | < 0.001 |
Borderline Hypernatremia | ||||
J69 Pneumonitis due to solids and liquids | 8.3 (3.53–17.2) | < 0.001 | 18.12 (6.74–40.49) | < 0.001 |
J80 Acute respiratory distress syndrome | 36.98 (26.99–50.73) | < 0.001 | 6.96 (3.4–12.65) | < 0.001 |
J96 Respiratory failure, not elsewhere classified | 6.88 (5.68–8.28) | < 0.001 | 2.95 (1.91–4.36) | < 0.001 |
N17 Acute kidney failure | 3.33 (2.21–4.81) | < 0.001 | 5.84 (3.41–9.33) | < 0.001 |
R57 Shock, not elsewhere classified | 22.39 (18.37–27.23) | < 0.001 | 6.19 (4.01–9.13) | < 0.001 |
Z51 Encounter for other aftercare | 7.05 (4.32–10.98) | < 0.001 | 7.93 (3.7–14.89) | < 0.001 |
Association Between Borderline Hyponatremia and Mortality | |||
OR (IC95%) | P | AIC | |
Classical Modela
| 1.98 (1.73–2.68) | <.001 | 8098.4 |
PheWAS Modelb
| 2.59 (2.28–2.94) | <.001 | 11,002 |
Final Modelc
| 1.57 (1.35–1.81) | <.001 | 7585.5 |
Association Between Borderline Hypernatremia and Mortality | |||
OR (IC95%) | P | AIC | |
Classical Modeld
| 3.72(1.53–8.45) | <.001 | 6077.9 |
PheWAS Modele
| 6.23(4.60–8.33) | <.001 | 8761.9 |
Final Modelf
| 3.47(2.43–4.90) | <.001 | 5920.8 |