Prevalence and impact of hyponatremia in chronic obstructive pulmonary disease. A systematic review and meta-analysis.
Hyponatremia is prevalent in COPD and AECOPD patients, with rates of 14% and 19% respectively, but significant variability among studies suggests careful interpretation of these findings.
Where it sits
this study against the rest of the lypressin corpusSummary and findings
This systematic review and meta-analysis measured the prevalence of hyponatremia in patients with chronic obstructive pulmonary disease (COPD) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The analysis included 11 studies, reporting a pooled prevalence of 14% in COPD patients and 19% in AECOPD patients. No treatment claims are made regarding the impact of hyponatremia on these conditions.
Abstract
Hyponatremia has been found to be associated with chronic obstructive pulmonary disease (COPD) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, there is a lack of systematic evidence on the prevalence and impact of hyponatremia in COPD and AECOPD patients. We performed a systematic search on three major databases for articles published on or before 31 July 2025. We included all the studies reporting the prevalence or number of hyponatremia cases in COPD patients (stable and exacerbation) aged 18 years and above. Pooled prevalence was calculated by a random effects model using RStudio. The Joanna Briggs Institute (JBI) tool was used for quality evaluation of the included studies. In this systematic review and meta-analysis, we included 11 studies out of 284 studies retrieved in the initial search. Of these 11 studies, three were COPD studies, and eight were AECOPD studies. The pooled prevalence of hyponatremia among COPD patients was 14% (95% CI: 4%-28%), with significant heterogeneity (<i>I</i>² = 98.3%, <i>p </i>< 0.0001). The pooled prevalence of hyponatremia in AECOPD patients was 19% (95% CI: 9%-32%), with significant heterogeneity (<i>I</i>² = 98.8%, <i>p </i>< 0.0001). Most of the studies showed that hyponatremia was not associated with mortality as an outcome of AECOPD. This study found a high prevalence of hyponatremia in both COPD and AECOPD patients; however, substantial heterogeneity (<i>I</i>² > 98%) necessitates cautious interpretation of pooled estimates. Future studies with standardized diagnostic criteria and larger sample sizes are needed to establish more precise prevalence rates.
Background
This paper addresses the prevalence and impact of hyponatremia in patients with chronic obstructive pulmonary disease (COPD) and acute exacerbations of COPD (AECOPD). Previous literature has suggested an association between hyponatremia and COPD, but systematic evidence was lacking. This study is significant as it aggregates data from multiple studies to provide a clearer picture of hyponatremia's prevalence in these patient populations.
Methods
The study conducted a systematic search across three major databases for articles published until July 31, 2025. It included studies reporting the prevalence or number of hyponatremia cases in COPD patients aged 18 years and older. A total of 11 studies were included in the analysis, with a focus on pooled prevalence calculated using a random effects model.
Results
The primary endpoint revealed that the pooled prevalence of hyponatremia among COPD patients was 14% (95% CI: 4%-28%), indicating a notable occurrence of this condition. For AECOPD patients, the pooled prevalence was found to be 19% (95% CI: 9%-32%). Both findings exhibited significant heterogeneity, with I² values of 98.3% and 98.8% respectively, and p-values less than 0.0001.
Interpretation
The findings suggest a high prevalence of hyponatremia in both COPD and AECOPD populations, which aligns with some prior studies but also raises concerns due to the significant heterogeneity observed. While the prevalence rates are statistically significant, the clinical relevance may be limited given the high variability among studies and the lack of consistent association with mortality outcomes. These confounds necessitate caution in applying these findings to clinical practice.
Key findings
- Pooled prevalence of hyponatremia among COPD patients was 14% (95% CI: 4%-28%), n=11 studies.
- Pooled prevalence of hyponatremia in AECOPD patients was 19% (95% CI: 9%-32%), n=11 studies.
- Significant heterogeneity in COPD studies with I² = 98.3%, p<0.0001.
- Significant heterogeneity in AECOPD studies with I² = 98.8%, p<0.0001.
- Most studies indicated hyponatremia was not associated with mortality in AECOPD.
Limitations
- Substantial heterogeneity in prevalence estimates (I² > 98%).
- Limited to studies published before July 31, 2025.
- Most studies did not find an association between hyponatremia and mortality.
- Small sample sizes in individual studies may affect reliability.
- Potential publication bias not addressed.