In this large multicenter observational cohort study of ICU patients, we aimed to assess the independent association of changes in serum sodium in the first 48 hours of ICU admission with in-hospital mortality for patients admitted with severe and mild hyponatremia, normonatremia, and hypernatremia.

An increase of serum sodium (Δ48 hr-[Na] > 5 mmol/L) in the first 48 hours of ICU admission was independently associated with a higher risk for mortality for patients admitted with normonatremia and hypernatremia.

Although not significant, a similar trend was found for patients admitted with mild hyponatremia.

For patients with severe hyponatremia, an increase in serum sodium in the first 48 hours of ICU admission was independently associated with a lower risk for mortality.

Adult patients were included if at least one serum sodium measurement within 24 hours of ICU admission and at least one serum sodium measurement 24–48 hours after ICU admission were available.

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