Daniel Shepshelovich1, Chiya Leibovitch2, Alina Klein2, Shirit Zoldan2, Gai Milo3, Tzippy Shochat4, Benaya Rozen-zvi5, Anat Gafter-Gvili6, Meir Lahav7. 1. Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: Shepshelovich@yahoo.com. 2. Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel. 3. Department of Nephrology, Rambam Health Care Campus, Haifa, Israel. 4. Statistical Consulting Unit, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel. 5. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel. 6. Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel. 7. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
Abstract
PURPOSE: To determine the distribution of etiologies for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in hospitalized patients and to characterize patients according to the different etiologies. METHODS: A single-center retrospective study including all patients diagnosed with SIADH in a large community hospital and tertiary center between 1.1.2007 and 1.1.2013. Two physicians reviewed every patient's medical file for predetermined relevant clinical data. RESULTS: The study cohort included 555 patients. The most common etiologies were malignancies and medication-induced SIADH, followed by idiopathic SIADH, pulmonary infections, pain and nausea, and central nervous system (CNS) disorders. Subgroup analysis according to etiology showed that CNS disorders were associated with more severe episodes of SIADH. Patients with idiopathic SIADH were older than patients with a specific diagnosis, had a lower urine osmolality, and required less treatment with hypertonic saline. Long-term survival was determined primarily by SIADH etiology rather than hyponatremia severity, with hazard ratios for death of up to 7.31 (95% CI 4.93-10.82, p<0.001) for patients with malignancy-associated SIADH as compared to patients with idiopathic SIADH. Hyponatremia grade at short-term follow-up was also predictive for long-term survival (HR 1.42 per grade, 95% CI 1.21-1.66, p<0.001). CONCLUSIONS: Patients with SIADH have different characteristics and a different prognosis according to SIADH etiology. Serum sodium concentration at short-term follow-up is predictive of long-term survival. These findings might have diagnostic and treatment-related implications.
PURPOSE: To determine the distribution of etiologies for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in hospitalized patients and to characterize patients according to the different etiologies. METHODS: A single-center retrospective study including all patients diagnosed with SIADH in a large community hospital and tertiary center between 1.1.2007 and 1.1.2013. Two physicians reviewed every patient's medical file for predetermined relevant clinical data. RESULTS: The study cohort included 555 patients. The most common etiologies were malignancies and medication-induced SIADH, followed by idiopathic SIADH, pulmonary infections, pain and nausea, and central nervous system (CNS) disorders. Subgroup analysis according to etiology showed that CNS disorders were associated with more severe episodes of SIADH. Patients with idiopathic SIADH were older than patients with a specific diagnosis, had a lower urine osmolality, and required less treatment with hypertonic saline. Long-term survival was determined primarily by SIADH etiology rather than hyponatremia severity, with hazard ratios for death of up to 7.31 (95% CI 4.93-10.82, p<0.001) for patients with malignancy-associated SIADH as compared to patients with idiopathic SIADH. Hyponatremia grade at short-term follow-up was also predictive for long-term survival (HR 1.42 per grade, 95% CI 1.21-1.66, p<0.001). CONCLUSIONS:Patients with SIADH have different characteristics and a different prognosis according to SIADH etiology. Serum sodium concentration at short-term follow-up is predictive of long-term survival. These findings might have diagnostic and treatment-related implications.
Authors: Julie Martin-Grace; Maria Tomkins; Michael W O'Reilly; Chris J Thompson; Mark Sherlock Journal: J Clin Endocrinol Metab Date: 2022-07-14 Impact factor: 6.134
Authors: Anna L Królicka; Adrianna Kruczkowska; Magdalena Krajewska; Mariusz A Kusztal Journal: Int J Environ Res Public Health Date: 2020-07-23 Impact factor: 3.390