Impact of hyponatremia on clinical outcomes in geriatric patients with fall-related injuries

Öz

Aim: This study aims to investigate the impact of hyponatremia on clinical outcomes in elderly patients presenting with fall-related injuries. The primary objective is to assess whether hyponatremia is independently associated with in-hospital mortality in this population. Material and Methods: This retrospective observational study included patients aged 65 years and older who presented with fall-related injuries to a tertiary emergency department between January 2022 and January 2025. Demographic data, clinical parameters, and laboratory values were extracted from electronic health records. Hyponatremia was defined as serum sodium <135 mmol/L. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. Restricted cubic spline regression and CHAID analysis were also performed to explore risk stratification patterns. Results: Among the 265 included patients, 23.8% (n = 63) had hyponatremia. In-hospital mortality occurred in 24.5% of the cohort, with a significantly higher rate in the hyponatremic group compared to normonatremic patients (51% vs. 16%, p < 0.001). Hyponatremia remained independently associated with mortality in multivariable analysis (adjusted OR 4.13, 95% CI 1.12–15.81, p = 0.035). The CHAID analysis identified hyponatremia and dependency in activities of daily living (ADL) as key predictors of poor outcomes. Conclusions: Hyponatremia at admission is a strong and independent predictor of in-hospital mortality in elderly patients with fall-related injuries. Early detection of electrolyte disturbances may help clinicians identify high-risk patients and improve outcome-based decision-making. Keywords: hyponatremia, elderly, mortality

Anahtar Kelimeler

• Hyponatremia
• elderly
• mortality.

Düşmeye bağlı yaralanmaları olan geriatik hastalarda hiponatreminin klinik sonuçlara etkisi

Öz

Amaç: Bu çalışma, düşmeye bağlı yaralanmalarla başvuran yaşlı hastalarda hiponatreminin klinik sonuçlar üzerindeki etkisini araştırmayı amaçlamaktadır. Birincil hedef, hiponatreminin bu popülasyonda hastane içi mortalite ile bağımsız olarak ilişkili olup olmadığını değerlendirmektir. Gereç ve Yöntem: Bu retrospektif gözlemsel çalışmaya, Ocak 2022 – Ocak 2025 tarihleri arasında üçüncü basamak acil servise düşmeye bağlı yaralanma ile başvuran 65 yaş ve üzeri hastalar dâhil edildi. Demografik veriler, klinik parametreler ve laboratuvar değerleri elektronik sağlık kayıtlarından elde edildi. Hiponatremi, serum sodyum <135 mmol/L olarak tanımlandı. Hastane içi mortalitenin bağımsız belirleyicilerini saptamak için çok değişkenli lojistik regresyon kullanıldı. Risk sınıflama modellerini incelemek amacıyla kısıtlı kübik spline regresyonu ve CHAID analizi yapıldı. Bulgular: Çalışmaya dâhil edilen 265 hastanın %23,8’i (n=63) hiponatremikti. Hastane içi mortalite oranı kohortun %24,5’inde görüldü ve hiponatremik grupta normonatremik hastalara kıyasla anlamlı derecede yüksekti (%51’e karşı %16, p<0,001). Çok değişkenli analizde hiponatremi, mortalite ile bağımsız olarak ilişkili kalmaya devam etti (düzeltilmiş OR 4,13; %95 GA 1,12–15,81; p=0,035). CHAID analizi, hiponatremi ve günlük yaşam aktivitelerinde (ADL) bağımlılığı kötü sonuçların temel belirleyicileri olarak tanımladı. Sonuçlar: Başvuru sırasında saptanan hiponatremi, düşmeye bağlı yaralanması olan yaşlı hastalarda hastane içi mortalitenin güçlü ve bağımsız bir öngörücüsüdür. Elektrolit bozukluklarının erken tespiti, klinisyenlerin yüksek riskli hastaları belirlemesine ve sonuç odaklı karar süreçlerini iyileştirmesine yardımcı olabilir.

Anahtar Kelimeler

• hiponatremi
• yaşlı
• mortalite

Kaynakça

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