Clinical outcomes of early fast compared to slow sodium correction rate in adults with severe hypernatremia: A...

Severe hypernatremia (serum sodium (SNa) ≥ 155 mmol/L) in critical illness is associated with high mortality; however, the optimal correction rate remains uncertain. We compared outcomes of fast (>0.5 mmol/L/h) versus slow (≤0.5 mmol/L/h) SNa correction within the first 24 h.

We performed a target trial emulation (TTE) using the MIMIC-IV database. Critically ill adults with severe hypernatremia were assigned to early fast or slow SNa correction. Propensity score matching with per-protocol analysis was applied. Primary outcome was 30-day mortality; secondary outcomes were 30-day hospital-free survival, intensive care unit (ICU) and hospital length of stay (LOS), and 7-day, 90-day, and in-hospital mortality. Outcomes were estimated using Cox proportional hazards and Fine-Gray competing risk models. Sensitivity analyses included entropy balancing and inverse probability treatment weighting.

Among 364,627 patients, 1861 were eligible; 233 received fast and 1628 slow correction. After matching, 430 patients were included. Fast correction significantly reduced 30-day mortality (adjusted HR 0.49, 95 % CI 0.28-0.84, p = 0.01) and improved 30-day hospital-free survival (adjusted HR 1.75, 95 % CI 1.40-2.18, p < 0.001). Fast correction was also associated with shorter ICU LOS (median 4 vs. 5 days, p = 0.002) and hospital LOS (8 vs. 11 days, p = 0.01). Sensitivity analyses confirmed robustness of these findings.

In this TTE of adults with severe hypernatremia, early fast correction of SNa was associated with lower mortality, greater hospital-free survival, and shorter ICU and hospital stays compared with slow correction.