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Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?

Several studies have demonstrated the impact of dysnatremias on mortality of intensive care unit (ICU) patients. The objective of this study was to assess whether dysnatremia is an independent factor to predict mortality in surgical critically ill patients admitted to ICU in postoperative phase. One...

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Autores principales: Nicolini, Edson A., Nunes, Roosevelt S., Santos, Gabriela V., da Silva, Silvana Lia, Carreira, Mariana M., Pellison, Fernanda G., Menegueti, Mayra G., Auxiliadora-Martins, Maria, Bellissimo-Rodrigues, Fernando, Feres, Marcus A., Basile-Filho, Anibal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340445/
https://www.ncbi.nlm.nih.gov/pubmed/28248872
http://dx.doi.org/10.1097/MD.0000000000006182
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author Nicolini, Edson A.
Nunes, Roosevelt S.
Santos, Gabriela V.
da Silva, Silvana Lia
Carreira, Mariana M.
Pellison, Fernanda G.
Menegueti, Mayra G.
Auxiliadora-Martins, Maria
Bellissimo-Rodrigues, Fernando
Feres, Marcus A.
Basile-Filho, Anibal
author_facet Nicolini, Edson A.
Nunes, Roosevelt S.
Santos, Gabriela V.
da Silva, Silvana Lia
Carreira, Mariana M.
Pellison, Fernanda G.
Menegueti, Mayra G.
Auxiliadora-Martins, Maria
Bellissimo-Rodrigues, Fernando
Feres, Marcus A.
Basile-Filho, Anibal
author_sort Nicolini, Edson A.
collection PubMed
description Several studies have demonstrated the impact of dysnatremias on mortality of intensive care unit (ICU) patients. The objective of this study was to assess whether dysnatremia is an independent factor to predict mortality in surgical critically ill patients admitted to ICU in postoperative phase. One thousand five hundred and ninety-nine surgical patients (58.8% males; mean age of 60.6 ± 14.4 years) admitted to the ICU in the postoperative period were retrospectively studied. The patients were classified according to their serum sodium levels (mmol/L) at admission as normonatremia (135–145), hyponatremia (<135), and hypernatremia (>145). APACHE II, SAPS III, and SOFA were recorded. The capability of each index to predict mortality of ICU and hospital mortality of patients was analyzed by multiple logistic regression. Hyponatremia did not have an influence on mortality in the ICU with a relative risk (RR) = 0.95 (0.43–2.05) and hospital mortality of RR = 1.40 (0.75–2.59). However, this association was greater in patients with hypernatremia mortality in the ICU (RR = 3.33 [95% confidence interval, CI 1.58–7.0]) and also in hospital mortality (RR = 2.9 [ 95% CI = 1.51–5.55). The pairwise comparison of ROC curves among the different prognostic indexes (APACHE II, SAPS III, SOFA) did not show statistical significance. The comparison of these indexes with serum sodium levels for general population, hyponatremia, and normonatremia was statistically significant (P < .001). For hypernatremia, the AUC and 95% CI for APACHE II, SAPS III, SOFA, and serum sodium level were 0.815 (0.713–0.892), 0.805 (0.702–0.885), 0.885 (0.794–0.945), and 0.663 (0.549–0.764), respectively. The comparison among the prognostic indexes was not statistically significant. Only SOFA score had a statistic difference compared with hypernatremia (P < .02). The serum sodium levels at admission, especially hypernatremia, may be used as an independent predictor of outcome in the surgical critically ill patients.
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spelling pubmed-53404452017-03-09 Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients? Nicolini, Edson A. Nunes, Roosevelt S. Santos, Gabriela V. da Silva, Silvana Lia Carreira, Mariana M. Pellison, Fernanda G. Menegueti, Mayra G. Auxiliadora-Martins, Maria Bellissimo-Rodrigues, Fernando Feres, Marcus A. Basile-Filho, Anibal Medicine (Baltimore) 3900 Several studies have demonstrated the impact of dysnatremias on mortality of intensive care unit (ICU) patients. The objective of this study was to assess whether dysnatremia is an independent factor to predict mortality in surgical critically ill patients admitted to ICU in postoperative phase. One thousand five hundred and ninety-nine surgical patients (58.8% males; mean age of 60.6 ± 14.4 years) admitted to the ICU in the postoperative period were retrospectively studied. The patients were classified according to their serum sodium levels (mmol/L) at admission as normonatremia (135–145), hyponatremia (<135), and hypernatremia (>145). APACHE II, SAPS III, and SOFA were recorded. The capability of each index to predict mortality of ICU and hospital mortality of patients was analyzed by multiple logistic regression. Hyponatremia did not have an influence on mortality in the ICU with a relative risk (RR) = 0.95 (0.43–2.05) and hospital mortality of RR = 1.40 (0.75–2.59). However, this association was greater in patients with hypernatremia mortality in the ICU (RR = 3.33 [95% confidence interval, CI 1.58–7.0]) and also in hospital mortality (RR = 2.9 [ 95% CI = 1.51–5.55). The pairwise comparison of ROC curves among the different prognostic indexes (APACHE II, SAPS III, SOFA) did not show statistical significance. The comparison of these indexes with serum sodium levels for general population, hyponatremia, and normonatremia was statistically significant (P < .001). For hypernatremia, the AUC and 95% CI for APACHE II, SAPS III, SOFA, and serum sodium level were 0.815 (0.713–0.892), 0.805 (0.702–0.885), 0.885 (0.794–0.945), and 0.663 (0.549–0.764), respectively. The comparison among the prognostic indexes was not statistically significant. Only SOFA score had a statistic difference compared with hypernatremia (P < .02). The serum sodium levels at admission, especially hypernatremia, may be used as an independent predictor of outcome in the surgical critically ill patients. Wolters Kluwer Health 2017-03-03 /pmc/articles/PMC5340445/ /pubmed/28248872 http://dx.doi.org/10.1097/MD.0000000000006182 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 3900
Nicolini, Edson A.
Nunes, Roosevelt S.
Santos, Gabriela V.
da Silva, Silvana Lia
Carreira, Mariana M.
Pellison, Fernanda G.
Menegueti, Mayra G.
Auxiliadora-Martins, Maria
Bellissimo-Rodrigues, Fernando
Feres, Marcus A.
Basile-Filho, Anibal
Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?
title Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?
title_full Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?
title_fullStr Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?
title_full_unstemmed Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?
title_short Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?
title_sort could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?
topic 3900
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340445/
https://www.ncbi.nlm.nih.gov/pubmed/28248872
http://dx.doi.org/10.1097/MD.0000000000006182
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