Pulmonary Vascular Disease |

Prognostic Value of Delta Change in Serum Sodium in Predicting Mortality and Length of Stay After Acute Pulmonary Embolism FREE TO VIEW

Sailaja Sakam, MD; Richard Peralta, MD; Bharat Bajantri, MD; Rahul Anand, MD; Sindhaghatta Venkatram, MD; Gilda Diaz-Fuentes, MD
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Bronx Lebanon Hospital Center, Bronx, NY

Chest. 2015;148(4_MeetingAbstracts):1005A. doi:10.1378/chest.2269823
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SESSION TITLE: Venous Thromboembolism Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Hyponatremia is common in patients presenting with pulmonary embolism (PE), and is an independent predictor of short-term mortality and hospital readmission. Hyponatremia and fluctuations in serum sodium concentrations have been associated with increased intensive care unit (ICU) mortality. The goal of this study was to correlate delta change in serum sodium (DNa) and outcomes of acute pulmonary embolism.

METHODS: Retrospective observational study including all adult patients admitted between January 2010 and December 2014 who underwent spiral chest CT to evaluate for acute PE. Exclusion criteria were: no pulmonary embolism by CT, NYHA class III/IV heart failure (HF), decompensated cirrhosis, SIADH, diabetic ketoacidosis, chronic hyponatremia, pneumonia and use of diuretics. Patients were divided into Survivors and Non-survivors to hospital admission. Demographic, laboratory, comorbid conditions, PESI (pulmonary embolism severity index) risk score, severity of PE and admission right ventricular systolic pressure (RVSP) were obtained. Primary outcomes of the study were correlation of DNa with mortality and length of stay.

RESULTS: 7000 patients underwent chest CT for suspected PE, 398(5.7%) were positive. Of the 398 patients, 57 died and 341 were discharged alive. Non-survivors were more likely to be elderly (64±17 versus 56±16;p=<0.001), admitted to ICU (57% versus 43% p<0.001), have higher pro-BNP values(5864±2165 versus 1041±139;p=0.032), elevated troponins (40% versus 21% ; p=0.008) and higher PESI score(164±51 versus 105±40;p=<0.001). Delta sodium correlated with mortality (7±3 versus 3±2 p<0.001) with a cut-off level of 4.2. We found no association between admission absolute serum sodium and mortality (138±8 versus 137±4;p=0.074). Non-survivors had a longer hospital LOS.

CONCLUSIONS: Delta change in serum sodium, pro-BNP, positive troponins, PESI risk score were all predicted of mortality in patients hospitalized with acute pulmonary embolism. There was no association between admission sodium and mortality. This is the first study showing an association between DNa and mortality in acute PE.

CLINICAL IMPLICATIONS: DNa should be incorporated as a predictor of mortality in patients with acute pulmonary embolism and no other causes for sodium abnormalities.

DISCLOSURE: The following authors have nothing to disclose: Sailaja Sakam, Richard Peralta, Bharat Bajantri, Rahul Anand, Sindhaghatta Venkatram, Gilda Diaz-Fuentes

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