Nasser, Ahmad, Chaba, Anis, Laupland, Kevin B., Ramanan, Mahesh, Tabah, Alexis, Attokaran, Antony G., Kumar, Aashish, McCullough, James, Shekar, Kiran, Garrett, Peter, McIlroy, Philippa, Luke, Stephen, Senthuran, Siva, Bellomo, Rinaldo, White, Kyle C., and Queensland Critical Care Research Network (QCCRN) (2024) ICU-acquired hypernatremia: Prevalence, patient characteristics, trajectory, risk factors, and outcomes. Critical Care and Resuscitation, 26. pp. 303-310.

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Abstract

Objective Knowledge of intensive care unit (ICU) acquired hypernatremia (ICU-AH) has been hampered by the absence of granular data and confounded by variable definitions and inclusion criteria.

Design Multicentre retrospective cohort study.

Setting Twelve ICUs in Queensland (QLD), Australia.

Participants Adult patients admitted to ICU from 2015 to 2021. Only the first ICU admission was considered, and we categorised patients into mild (146–150 mmol·L−1), moderate (151–155 mmol·L−1) and severe (>155 mmol·L−1) ICU-acquired hypernatremia.

Main outcome measure We aimed to study the prevalence of ICU-AH, patient characteristics, trajectory, risk factors, and outcomes.

Results Data from 55,255 ICU admissions were included in the analysis, of which 4146 (7.5 %) patients had ICU-AH. These were subcategorised into mild (n = 2,670, 4.8 %), moderate (n = 1,073, 1.9 %) and severe (n = 403, 0.73 %) forms. Median time to diagnosis was 4 (2–6) d after ICU admission, while median time to peak serum sodium level was 5 (3–8) d. The median maximum sodium level across the cohort was 149 (147–152) mmol·L−1. The sodium correction rate was 1 mmol·L−1 per day, taking a median of 3 d (1–5) for sodium levels to return below 145 mmol·L−1. APACHE III score, invasive ventilation, fever, and diuretic use on the day before hypernatremia were independent risk factors for moderate or severe ICU-AH. After adjusting for confounders, all levels of hypernatremia were independently associated with an increased risk of 30-d in-hospital mortality.

Conclusions In a large multicentric study of critically ill patients, ICU-acquired hypernatremia occurred in one in eight admissions after a median of four days in the ICU and was preceded by identifiable and modifiable risk factors. If severe, its correction was slow, and normalisation was delayed. After adjusting for other factors, all levels of hypernatremia were an independent risk factor for 30-d in-hospital mortality.

Item ID:	84859
Item Type:	Article (Research - C1)
ISSN:	2652-9335
Copyright Information:	© 2024 The Authors. Published by Elsevier B.V. on behalf of College of Intensive Care Medicine of Australia and New Zealand. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Additional Information:	The names of the Collaborators - Queensland Critical Care Research Network Group are listed at the end of the article.
Date Deposited:	15 Apr 2025 04:33
FoR Codes:	32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320212 Intensive care @ 100%
SEO Codes:	28 EXPANDING KNOWLEDGE > 2801 Expanding knowledge > 280103 Expanding knowledge in the biomedical and clinical sciences @ 100%
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