Ward Kenneth, Page Valda D, Song Juhee, Amaram-Davila Jaya Sheela, Mamlouk Omar, Abudayyeh Ala
Section of Nephrology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Clin Kidney J. 2025 Jan 24;18(3):sfaf023. doi: 10.1093/ckj/sfaf023. eCollection 2025 Mar.
Hyponatraemia in cancer patients admitted to the hospital is associated with longer stays, higher costs and increased mortality. We examined the impact of hyponatraemia correction on survival in hospitalized patients with advanced cancer.
We reviewed records of patients with solid tumours who were hospitalized between January 2018 and December 2022 with serum sodium ≤125 mEq/l at admission. Cox regression analysis examined associations of demographic and clinical characteristics, including sodium levels at admission and discharge, with overall survival.
Among 1100 patients, median sodium levels were 122 mEq/l at admission and 132 mEq/l at discharge. A total of 165 patients (15%) died during hospitalization and 414 of 688 discharged home (60.2%) died within 5 years. Multivariable analysis showed that among patients discharged alive, a decrease in sodium from admission to discharge ( = .0081), sodium ≤125 mEq/l at discharge [hazard ratio (HR) 1.42; = .0382], albumin <3.5 g/dl at admission (HR 1.48; < .0001), metastatic stage (HR 1.37; = .0004), emergency admission (HR 1.20; = .0390), discharge to hospice (HR 2.57; < .0001), lung cancers (HR 1.51; = .0044) and metastatic disease (HR 1.37; = .0004) were associated with poorer overall survival. Sodium level at admission was not a significant predictor of overall survival from hospital admission. In patients with metastatic disease, an increase in sodium from admission to discharge was associated with improved overall survival from hospital discharge.
Correcting hyponatraemia in hospitalized patients with metastatic cancer increases overall survival, but metastatic cancer in itself is also associated with poor survival. This highlights the importance of early palliative care involvement in patients with advanced cancer.
入院的癌症患者发生低钠血症与住院时间延长、费用增加及死亡率上升相关。我们研究了低钠血症纠正对晚期癌症住院患者生存的影响。
我们回顾了2018年1月至2022年12月期间因实体瘤住院且入院时血清钠≤125 mEq/L的患者记录。Cox回归分析研究了人口统计学和临床特征（包括入院和出院时的钠水平）与总生存的关联。
1100例患者中，入院时钠水平中位数为122 mEq/L，出院时为132 mEq/L。共有165例患者（15%）在住院期间死亡，688例出院回家的患者中有414例（60.2%）在5年内死亡。多变量分析显示，在存活出院的患者中，从入院到出院钠水平降低（P = 0.0081）、出院时钠≤125 mEq/L[风险比（HR）1.42；P = 0.0382]、入院时白蛋白<3.5 g/dl（HR 1.48；P < 0.0001）、转移分期（HR 1.37；P = 0.0004）、急诊入院（HR 1.20；P = 0.0390）、出院至临终关怀机构（HR 2.57；P < 0.0001）、肺癌（HR 1.51；P = 0.0044）和转移疾病（HR 1.37；P = 0.0004）与较差的总生存相关。入院时的钠水平不是从入院起总生存的显著预测因素。在有转移疾病患者中，从入院到出院钠水平升高与出院后总生存改善相关。
纠正转移性癌症住院患者的低钠血症可提高总生存，但转移性癌症本身也与生存不佳相关。这凸显了早期姑息治疗介入晚期癌症患者的重要性。
