Vikash Kumar, MD1, Vijay Gayam, MD1, Praneeth Bandaru, MD1, Arnold Forlemu, MD, MPH1, Dhir Gala, BS2, Saigopal R. Gujjula, 3, Fnu Vikash, MD4, Vinaya Gaduputi, MD5, Madhavi Reddy, MD1 1Brooklyn Hospital Center, Brooklyn, NY; 2American University of the Caribbean School of Medicine, Plainview, NY; 3American University of Antigua, Coolidge, Saint John, Antigua and Barbuda; 4Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY; 5Blanchard Valley Health System, Findlay, OH
Introduction: Hyponatremia has been associated with higher mortality rates and longer hospital stays in patients with solid tumors. The existing literature contains limited information on the connection between hyponatremia and colorectal cancer (CRC). Thus, our study aimed to assess the impact of hyponatremia on mortality, morbidity, and resource usage in patients with CRC.
Methods: A retrospective analysis using the NIS database 2019 - 2020 and ICD- 10 codes was conducted to examine the impact of hyponatremia on mortality, morbidity, and resource utilization in patients with CRC. Categorical variables were compared using chi-square tests, while continuous variables were compared using t-tests. Multivariable regression analyses were performed, adjusting for demographics, hospital-level characteristics, and relevant comorbidities. Confounding variables were adjusted using multivariate logistic and linear regression analyses. These included: gender, race, Charlson Comorbidity Index, congestive heart failure, cirrhosis, hypothyroidism, adrenal insufficiency, alcohol use disorder, and hospital characteristics.
Results: A total of 337,190 patients with a primary diagnosis of CRC were included in the study, of which 12.6% (3,369) presented with hyponatremia. The in-hospital mortality rate was 7.8% for patients with hyponatremia, compared to 4.1% for patients without hyponatremia. After adjusting for confounding factors, hyponatremia was found to significantly increase the odds of mortality (adjusted odds ratio [aOR] for mortality 1.85, 95% [CI]: 1.68–2.03, P < 0.01). Patients with colon cancer and hyponatremia also had higher odds of developing sepsis (odds ratio = 2.60), acute kidney injury (OR= 2.63), peritonitis (OR = 2.25), and ICU admission (odds ratio = 2.12) (Table 1). Additionally, Hyponatremia was associated with increased resource utilization, as evidenced by a longer mean length of stay and higher mean total hospital charges.
Discussion: The findings from this retrospective analysis reveal that hyponatremia has a considerable adverse effect on the mortality, morbidity, and utilization of resources in individuals with CRC. This significantly greater odds of mortality highlighting the importance of monitoring sodium levels and implementing appropriate interventions to prevent and manage this electrolyte imbalance. The study emphasizes how crucial it is to treat and manage hyponatremia in order to enhance patient outcomes and allocate healthcare resources in this population more effectively.
Outcomes
CRC With Hyponatremia
CRC without Hyponatremia
Adjusted OR (95% CI)
P-value
%
%
Mortality
7.8
4.1
1.85 (1.68– 2.03)
< 0.01
LOS, days
7.06
5.90
1.16 (1.49–2.67)
< 0.01
Total Charges, USD
111,412
97,281
16,320 (12,498–32,143)
< 0.01
Acute Kidney Injury
29.0
16.7
2.63 (2.50–2.76)
< 0.01
Peritonitis
2.81
1.11
2.25 (1.97–2.57)
< 0.01
ICU admission
0.27
0.07
2.12 (1.48– 3.04)
< 0.01
Cerebral Edema
0.32
0.46
1.06 (0.82–1.38)
0.69
Altered Mental Status
0.65
0.59
1.20 (0.85–1.68)
0.28
Sepsis
11.1
4.6
2.06 (2.40–2.81)
< 0.01
Disclosures:
Vikash Kumar indicated no relevant financial relationships.
Vijay Gayam indicated no relevant financial relationships.
Praneeth Bandaru indicated no relevant financial relationships.
Arnold Forlemu indicated no relevant financial relationships.
Dhir Gala indicated no relevant financial relationships.
Saigopal Gujjula indicated no relevant financial relationships.
Fnu Vikash indicated no relevant financial relationships.
Vinaya Gaduputi indicated no relevant financial relationships.
Madhavi Reddy indicated no relevant financial relationships.
Vikash Kumar, MD1, Vijay Gayam, MD1, Praneeth Bandaru, MD1, Arnold Forlemu, MD, MPH1, Dhir Gala, BS2, Saigopal R. Gujjula, 3, Fnu Vikash, MD4, Vinaya Gaduputi, MD5, Madhavi Reddy, MD1. P3007 - Prognostic Impact of Hyponatremia in Patients with Colon Cancer: A Nationwide Analysis 2019-2020, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
