Tsipotis E, et al. – This report focused on the hospital–associated hypernatremia spectrum and clinical outcomes in unselected hospitalized adults. Outcomes disclosed that in unselected hospitalized patients, the hypernatremia spectrum was independently associated with increased in–hospital mortality and increased resource consumption.

Methods

• The physicians reviewed the discharge data of 19,072 unselected hospitalized adults. 
• The crude relationship between serum [Na+] and mortality defined hypernatremia as serum [Na+] > 142 mEq/L. 
• Patients with community–acquired hypernatremia or hospital–acquired hypernatremia were compared to normonatremic patients (admission [Na+] 138–142 mEq/L) in terms of in–hospital mortality, length of stay, and discharge disposition.
• Patients with community–acquired hypernatremia whose hypernatremia worsened during hospitalization were compared to those without aggravation.

Results

• Investigations revealed that community–acquired hypernatremia occurred in 21% of hospitalized patients and was associated with an adjusted odds ratio (OR) of 1.67 (95% confidence interval [CI] 1.38, 2.01) for in–hospital mortality, and 1.44 (95% CI 1.32, 1.56) for discharge to a short–/long–term care facility, and an adjusted 10% (95% CI, 7%–13%) increase in length of stay.
• Hospital–acquired hypernatremia developed in 25.9% of hospitalized patients and was associated with an adjusted OR of 3.17 (95% CI 2.45, 4.09) for in–hospital mortality, and 1.45 (95% CI 1.32, 1.59) for discharge to a facility, and an adjusted 49% (95% CI 44%, 53%) increase in length of stay.
• Hospital–aggravated hypernatremia developed in 11.7% of patients with community–acquired hypernatremia and was associated with greater risk of in–hospital mortality (adjusted OR 1.84; 95% CI 1.32, 2.56) and discharge to a facility (adjusted OR 2.14; 95% CI 1.71, 2.69), and an adjusted 16% (95% CI 7%–27%) increase in length of stay.