Patterns of Drug Use and Serum Sodium Concentrations in Older Hospitalized Patients

A Latent Class Analysis Approach

Richard J. Woodman, Karen M. Wood, Aline Kunnel, Maneesha Dedigama, Matthew A. Pegoli, Roy L. Soiza, Arduino A. Mangoni (Corresponding Author)

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Several drugs may lower serum sodium concentrations (NaC) in older patients. However, distinguishing their individual effects is particularly difficult in this population because of the high prevalence of polypharmacy and disease states that are per se associated with hyponatremia.

OBJECTIVES: Our objective was to identify specific patterns of medication use in older hospitalized patients and determine whether these patterns were associated with serum NaC.

METHODS: We collected clinical and demographic data, pre-admission drugs, Drug Burden Index (DBI) score, and average NaC during hospitalization in a consecutive series of older medical patients (n = 101, mean ± standard deviation [SD] age 87 ± 6 years). We used latent class analysis (LCA) to identify specific patterns of drug use and multivariate regression to determine the associations between 14 separate drug classes, identified patterns of drug use, and NaC.

RESULTS: LCA revealed three patterns: lower overall drug use (class 1), anticoagulant use and higher drug use (class 2), and antiplatelet use (class 3). Mean (±SD) DBI score in each class was 2.7 ± 1.3, 3.3 ± 1.6, and 2.4 ± 1.5, respectively (p = 0.04). Mean (± SD) NaC in classes 1, 2, and 3 were 140.6 ± 6.8, 138.7 ± 5.3, and 136.5 ± 4.7 mmol/l, respectively (p = 0.006). After adjustment for age, sex, Charlson Comorbidity Index score, estimated glomerular filtration rate (eGFR), DBI score, and digoxin use, mean NaC in class 2 and class 3 was significantly lower than in class 1 (-3.9 mmol/l; 95% confidence interval [CI] -7.1 to -0.8, p = 0.01 and -5.2 mmol/l; 95% CI -7.9 to -2.5, p < 0.001, respectively). Mean serum NaC was not significantly associated with any of the 14 individually assessed drug classes. In addition to latent class, increasing age and higher eGFR were also independently associated with lower serum NaC (p = 0.002 and p = 0.03, respectively).

CONCLUSION: LCA enabled us to identify patterns of drug use associated with lower serum NaC in older inpatients. Our results suggest that older patients using antiplatelets or anticoagulants are especially at risk of lower serum NaC.

Original languageEnglish
Pages (from-to)383-391
Number of pages9
JournalDrugs - real world outcomes
Volume3
Issue number4
Early online date27 Oct 2016
DOIs
Publication statusPublished - Dec 2016

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Sodium
Serum
Pharmaceutical Preparations
Glomerular Filtration Rate
Anticoagulants
Confidence Intervals
Polypharmacy
Hyponatremia
Digoxin
Comorbidity
Inpatients
Hospitalization
Demography
Population

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Patterns of Drug Use and Serum Sodium Concentrations in Older Hospitalized Patients : A Latent Class Analysis Approach. / Woodman, Richard J.; Wood, Karen M.; Kunnel, Aline; Dedigama, Maneesha; Pegoli, Matthew A.; Soiza, Roy L.; Mangoni, Arduino A. (Corresponding Author).

In: Drugs - real world outcomes, Vol. 3, No. 4, 12.2016, p. 383-391.

Research output: Contribution to journalArticle

Woodman, Richard J. ; Wood, Karen M. ; Kunnel, Aline ; Dedigama, Maneesha ; Pegoli, Matthew A. ; Soiza, Roy L. ; Mangoni, Arduino A. / Patterns of Drug Use and Serum Sodium Concentrations in Older Hospitalized Patients : A Latent Class Analysis Approach. In: Drugs - real world outcomes. 2016 ; Vol. 3, No. 4. pp. 383-391.
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AU - Woodman, Richard J.

AU - Wood, Karen M.

AU - Kunnel, Aline

AU - Dedigama, Maneesha

AU - Pegoli, Matthew A.

AU - Soiza, Roy L.

AU - Mangoni, Arduino A.

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N2 - BACKGROUND: Several drugs may lower serum sodium concentrations (NaC) in older patients. However, distinguishing their individual effects is particularly difficult in this population because of the high prevalence of polypharmacy and disease states that are per se associated with hyponatremia.OBJECTIVES: Our objective was to identify specific patterns of medication use in older hospitalized patients and determine whether these patterns were associated with serum NaC.METHODS: We collected clinical and demographic data, pre-admission drugs, Drug Burden Index (DBI) score, and average NaC during hospitalization in a consecutive series of older medical patients (n = 101, mean ± standard deviation [SD] age 87 ± 6 years). We used latent class analysis (LCA) to identify specific patterns of drug use and multivariate regression to determine the associations between 14 separate drug classes, identified patterns of drug use, and NaC.RESULTS: LCA revealed three patterns: lower overall drug use (class 1), anticoagulant use and higher drug use (class 2), and antiplatelet use (class 3). Mean (±SD) DBI score in each class was 2.7 ± 1.3, 3.3 ± 1.6, and 2.4 ± 1.5, respectively (p = 0.04). Mean (± SD) NaC in classes 1, 2, and 3 were 140.6 ± 6.8, 138.7 ± 5.3, and 136.5 ± 4.7 mmol/l, respectively (p = 0.006). After adjustment for age, sex, Charlson Comorbidity Index score, estimated glomerular filtration rate (eGFR), DBI score, and digoxin use, mean NaC in class 2 and class 3 was significantly lower than in class 1 (-3.9 mmol/l; 95% confidence interval [CI] -7.1 to -0.8, p = 0.01 and -5.2 mmol/l; 95% CI -7.9 to -2.5, p < 0.001, respectively). Mean serum NaC was not significantly associated with any of the 14 individually assessed drug classes. In addition to latent class, increasing age and higher eGFR were also independently associated with lower serum NaC (p = 0.002 and p = 0.03, respectively).CONCLUSION: LCA enabled us to identify patterns of drug use associated with lower serum NaC in older inpatients. Our results suggest that older patients using antiplatelets or anticoagulants are especially at risk of lower serum NaC.

AB - BACKGROUND: Several drugs may lower serum sodium concentrations (NaC) in older patients. However, distinguishing their individual effects is particularly difficult in this population because of the high prevalence of polypharmacy and disease states that are per se associated with hyponatremia.OBJECTIVES: Our objective was to identify specific patterns of medication use in older hospitalized patients and determine whether these patterns were associated with serum NaC.METHODS: We collected clinical and demographic data, pre-admission drugs, Drug Burden Index (DBI) score, and average NaC during hospitalization in a consecutive series of older medical patients (n = 101, mean ± standard deviation [SD] age 87 ± 6 years). We used latent class analysis (LCA) to identify specific patterns of drug use and multivariate regression to determine the associations between 14 separate drug classes, identified patterns of drug use, and NaC.RESULTS: LCA revealed three patterns: lower overall drug use (class 1), anticoagulant use and higher drug use (class 2), and antiplatelet use (class 3). Mean (±SD) DBI score in each class was 2.7 ± 1.3, 3.3 ± 1.6, and 2.4 ± 1.5, respectively (p = 0.04). Mean (± SD) NaC in classes 1, 2, and 3 were 140.6 ± 6.8, 138.7 ± 5.3, and 136.5 ± 4.7 mmol/l, respectively (p = 0.006). After adjustment for age, sex, Charlson Comorbidity Index score, estimated glomerular filtration rate (eGFR), DBI score, and digoxin use, mean NaC in class 2 and class 3 was significantly lower than in class 1 (-3.9 mmol/l; 95% confidence interval [CI] -7.1 to -0.8, p = 0.01 and -5.2 mmol/l; 95% CI -7.9 to -2.5, p < 0.001, respectively). Mean serum NaC was not significantly associated with any of the 14 individually assessed drug classes. In addition to latent class, increasing age and higher eGFR were also independently associated with lower serum NaC (p = 0.002 and p = 0.03, respectively).CONCLUSION: LCA enabled us to identify patterns of drug use associated with lower serum NaC in older inpatients. Our results suggest that older patients using antiplatelets or anticoagulants are especially at risk of lower serum NaC.

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