Hyponatremia predicts poor outcomes in patients hospitalized with acute sickle cell crisis

Référence

Rech J, Yao K, Bachmeyer C, et al. Prognostic value of hyponatremia during acute painful episodes in sickle cell disease. Am J Med 2020;133:e465-e482.

Sommaire

Patients with sickle cell disease who are hospitalized with an uncomplicated acute pain crisis are at risk of developing complications such as acute chest syndrome. In this study, investigators examined whether hyponatremia can be used as an early predictor of such complications. The cohort included every adult sickle cell disease patient hospitalized with an uncomplicated acute pain crisis at a referral center in France during 2 disjointed periods (1218 hospital stays, 406 patients). The investigators recorded plasma sodium concentration within 48 hours of admission. The primary outcome was a composite of acute chest syndrome (ACS), intensive care unit (ICU) transfer, red blood cell simple or exchange transfusion, or inpatient death. In the overall cohort, 7% of patients developed ACS, 6% required transfusion, and 4% were transferred to the ICU. There were no deaths in the study population. After adjusting for risk factors for poor outcomes, hyponatremia (plasma sodium concentration < 135 mmol/L) was associated with a higher risk of the primary outcome (odds ratio [OR] 1.95; 95% CI 1.30 - 2.91; P = .001). Specifically, hyponatremia was associated with increased risk of ACS (OR 1.95; 1.20 - 3.17; P = .008) and red blood cell transfusion (OR 2.71; 1.58 - 4.65; P < .001), but was not significantly associated with ICU transfer. A decreasing sodium concentration was also noted in patients with evolving acute chest syndrome. Further, hospital length of stay was increased by 1.1 days in patients with hyponatremia at admission (0.5 - 1.6 days; P < .001).