Does hyponatremia predict worse outcomes in gastric cancer?: A nationwide study.

person Jorge Franco Universidad Latina, San José, Costa Rica info_outline Jorge Franco, Diana Franco, Umer Farooq, Irene Ma

Authors person Jorge Franco Universidad Latina, San José, Costa Rica info_outline Jorge Franco, Diana Franco, Umer Farooq, Irene Ma Organizations Universidad Latina, San José, Costa Rica, Loyola Medicine/MacNeal Hospital, Berwyn, IL Abstract Disclosures Research Funding No funding received Background: Hyponatremia has historically been reported to increase mortality and length of stay in hospitalized patients with solid tumors. There are sparse reports of hyponatremia linked to gastric cancer in the published literature. Therefore, we evaluated mortality, morbidity, and resource utilization in gastric cancer patients secondary to hyponatremia. Methods: We investigated the National Inpatient Sample 2019 employing International Classification of Diseases-10 (ICD-10) codes to include adult patients with gastric cancer. Effect of hyponatremia was studied on mortality, morbidity, and resource utilization. Analyses were performed using STATA (v 14.2), considering 2 sided P < 0.05 as statistically significant. Proportions were compared using Fisher exact test and continuous variables using Student’s t-test. Confounding variables were adjusted using multivariate logistic and linear regression analyses. These included: gender, race, Charlson Comorbidity Index, chronic kidney disease, congestive heart failure, cirrhosis, nephrotic syndrome, hypothyroidism, adrenal insufficiency, alcohol use disorder, and admission for hypovolemia or psychogenic polydipsia and various patient and hospital characteristics. Results: Out of 43,015 patients with gastric cancer in 2019, 13.59% (5,845) had hyponatremia on presentation (Table. 1). Patients with hyponatremia had 12.23% in-hospital mortality, while 6.69% for patients without hyponatremia. After adjusting for confounders, hyponatremia imparted higher odds of mortality (Adjusted odds ratio (aOR) for mortality 1.89, 95% confidence interval (CI): 1.54–2.32, P < 0.01). Hyponatremia also resulted in higher resource utilization marked by the length of stay, hospital charges, and ICU admission (higher mean LOS by 2.09 days, higher mean total hospital charges by $22,320, and higher odds of ICU admission). In addition, patients with hyponatremia had higher odds of acute renal failure (aOR 2.38, 95% CI: 2.05–2.77, P < 0.01). Rates of cerebral edema and altered mental status were equal between the two study groups ( P > 0.05). Conclusions: Hyponatremia in gastric cancer patients had a prevalence of 13.59% and resulted in increased in-hospital mortality. Whether time-efficient treatment of hyponatremia would help reduce mortality and improve outcomes remains to be determined in future studies. Outcomes With Hyponatremia Without Hyponatremia Adjusted OR (95% CI) P -value % % Mortality 12.23 6.69 1.89 (1.54–2.32) < 0.01 LOS, days 8.90 6.88 2.09 (1.49–2.67) < 0.01 Total Charges, USD 111,412 87,281 22,320 (12,498–32,143) < 0.01 Acute Renal Failure 30.28 16.24 2.38 (2.05–2.77) < 0.01 Intubation 5.21 3.56 1.48 (1.08–2.02) 0.01 ICU admission 6.33 4.29 1.49 (1.12– 1.98) < 0.01 Cerebral Edema 0.59 0.67 0.89 (0.39–1.82) 0.68 Altered Mental Status 0.59 0.49 1.41 (0.62–3.17) 0.41 OR: Odds ratio, 95% CI: 95% Confidence Interval, LOS: Length of Stay