{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T12:56:25Z","timestamp":1698152185832},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>Whether unaccounted determinants of hyponatremia, rather than water excess per se, primarily associate with mortality in observational studies has not been explicitly examined.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective cohort study of the association between hyponatremia and mortality, stratified by outpatient diuretic use in three strata.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>An inception cohort of 13,661 critically ill patients from a tertiary medical center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Measurements and Main Results:<\/jats:title>\n            <jats:p>Admission serum sodium concentrations, obtained within 12 hours of admission to the ICU, were the primary exposure. Hyponatremia was associated with 1.82 (95% CI, 1.56\u20132.11; <jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.001) higher odds of mortality, yet differed according to outpatient diuretic use (multiplicative interaction between thiazide and serum sodium &lt; 133 mEq\/L; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.002). Although hyponatremia was associated with a three-fold higher (odds ratio, 3.11; 95% CI, 2.32\u20134.17; <jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.001) odds of mortality among those prescribed loop diuretics, no increase of risk was observed among thiazide diuretic users (odds ratio, 0.87; 95% CI, 0.47\u20131.51; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.63). When examined as a continuous variable, each one mEq\/L higher serum sodium was associated with 8% (odds ratio, 0.92; 95% CI, 0.90\u20130.94; <jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.001) lower odds of mortality in loop diuretic patients and 5% (odds ratio, 0.95; 95% CI, 0.93\u20130.96, <jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.001) lower in diuretic na\u00efve patients, but was not associated with mortality risk among thiazide users (odds ratio, 0.99; 95% CI, 0.95\u20131.02; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.45).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Hyponatremia is not uniformly associated with increased mortality, but differs according to diuretic exposure. Our results suggest that the underlying pathophysiologic factors that lead to water excess, rather water excess itself, account in part for the association between hyponatremia and poor outcomes. More accurate estimations about the association between hyponatremia and outcomes might influence clinical decision-making.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/cce.0000000000000074","type":"journal-article","created":{"date-parts":[[2020,1,27]],"date-time":"2020-01-27T13:56:36Z","timestamp":1580133396000},"page":"e0074","source":"Crossref","is-referenced-by-count":1,"title":["Do Hyponatremia or Its Underlying Mechanisms Associate With Mortality Risk in Observational Data?"],"prefix":"10.1097","volume":"2","author":[{"given":"John","family":"Danziger","sequence":"first","affiliation":[{"name":"Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joon","family":"Lee","sequence":"additional","affiliation":[{"name":"Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA."},{"name":"School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger G.","family":"Mark","sequence":"additional","affiliation":[{"name":"Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leo Anthony","family":"Celi","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA."},{"name":"Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth J.","family":"Mukamal","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, 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