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Impact of organ dysfunction on outcomes in pediatric hypernatremia: a retrospective observational study
Ayumi Mihara1, Kentaro Nishi2, Itaru Hayakawa3
1Center for Postgraduate Education and Training, National Center for Child Health and Development (NCCHD), 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan.
Insights
Pediatric hypernatremia, often hospital-acquired in complex cases, is linked to mortality. The number of organ dysfunctions is a key predictor of death in these children.
Area of Science:
- Pediatric critical care medicine
- Nephrology
- Clinical epidemiology
Background:
- Hypernatremia in children is linked to increased mortality.
- The specific clinical factors and outcomes in pediatric hypernatremia require further clarification.
Purpose of the Study:
- To elucidate the clinical characteristics of pediatric hypernatremia.
- To identify prognostic factors for mortality in pediatric hypernatremia, including the role of organ dysfunction.
Main Methods:
- Retrospective observational study of pediatric patients (under 18 years) with serum sodium ≥ 150 mmol/L.
- Analysis of patient demographics, clinical course, mortality, and intracranial hemorrhage.
- Kaplan-Meier and Cox proportional hazard analyses for survival and risk factors.
Main Results:
- 116 pediatric patients (1.2%) had hypernatremia; 91% had chronic diseases and hospital-acquired cases.
- High rates of medication use (85%), intravenous fluids (80%), and nil per os (63%) prior to onset.
- 180-day survival rate was 81.9%. Four or more organ dysfunctions significantly predicted death (OR 5.83).
- Two patients (2%) developed new subdural hematomas.
Conclusions:
- Pediatric hypernatremia primarily affects medically complex children and is often hospital-acquired.
- The extent of organ dysfunction is a significant predictor of mortality in pediatric hypernatremia.
- Understanding these factors can aid in risk stratification and management.
Background:
Hypernatremia is associated with increased mortality risk in pediatric patients. However, its impact on outcomes remains unclear. This study aimed to clarify the clinical backgrounds of contemporary children with hypernatremia and identify prognostic factors, including the impact of organ dysfunction on mortality.
Methods:
We conducted a retrospective observational study of children under 18 years of age with hypernatremia (serum sodium ≥ 150 mmol/L) at a tertiary pediatric hospital in Japan between December 2021 and May 2023. Patient characteristics, clinical course, mortality rate, and occurrence of intracranial hemorrhage were analyzed. Kaplan-Meier and multivariable Cox proportional hazard analyses assessed 180-day survival and mortality risk factors.
Results:
Out of 9,208 children admitted, 116 (1.2%) with hypernatremia were finally analyzed; 91% had underlying chronic diseases and 91% had hospital-acquired hypernatremia. Before onset, 85% had medication related to hypernatremia, 80% received intravenous fluids, and 63% were managed with nil per os. Survival rates were 87.9%, 83.6%, and 81.9% at 30, 90, and 180 days from the onset of hypernatremia, respectively. Cox proportional hazard analysis reveal that four or more organ dysfunctions (odds ratio 5.83, 95%CI 1.92-17.7, P = 0.002) significantly correlated with death, after adjusting for intravenous fluids and peak sodium level. Two patients (2%) developed new subdural hematomas after the onset of hypernatremia.
Conclusions:
Pediatric hypernatremia predominantly occurs in medically complex children and is mostly hospital-acquired. The number of organ dysfunctions is a strong predictor of mortality in children with hypernatremia.
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