Waikar Sushrut S, Mount David B, Curhan Gary C
Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. 02115, USA.
Am J Med. 2009 Sep;122(9):857-65. doi: 10.1016/j.amjmed.2009.01.027.
Hyponatremia is the most common electrolyte abnormality in hospitalized individuals.
To investigate the association between serum sodium concentration and mortality, we conducted a prospective cohort study of 98,411 adults hospitalized between 2000 and 2003 at 2 teaching hospitals in Boston, Massachusetts. The main outcome measures were in-hospital, 1-year, and 5-year mortality. Multivariable logistic regression and Cox proportional hazards models were used to compare outcomes in patients with varying degrees of hyponatremia against those with normal serum sodium concentration.
Hyponatremia (serum sodium concentration <135 mEq/L) was observed in 14.5% of patients on initial measurement. Compared with patients with normonatremia (135-144 mEq/L), those with hyponatremia were older (67.0 vs 63.1 years, P <.001) and had more comorbid conditions (mean Deyo-Charlson Index 1.9 vs 1.4, P <.001). In multivariable-adjusted models, patients with hyponatremia had an increased risk of death in hospital (odds ratio 1.47, 95% confidence interval [CI], 1.33-1.62), at 1 year (hazard ratio 1.38, 95% CI, 1.32-1.46), and at 5 years (hazard ratio 1.25, 95% CI, 1.21-1.30). The increased risk of death was evident even in those with mild hyponatremia (130-134 mEq/L; odds ratio 1.37, 95% CI, 1.23-1.52). The relationship between hyponatremia and mortality was pronounced in patients admitted with cardiovascular disease, metastatic cancer, and those admitted for procedures related to the musculoskeletal system. Resolution of hyponatremia during hospitalization attenuated the increased mortality risk conferred by hyponatremia.
Hyponatremia, even when mild, is associated with increased mortality.
低钠血症是住院患者中最常见的电解质异常。
为研究血清钠浓度与死亡率之间的关联，我们对1998年至2001年间在马萨诸塞州波士顿市2家教学医院住院的98411名成年人进行了一项前瞻性队列研究。主要结局指标为住院期间、1年和5年死亡率。采用多变量逻辑回归和Cox比例风险模型，比较不同程度低钠血症患者与血清钠浓度正常患者的结局。
初次测量时，14.5%的患者存在低钠血症（血清钠浓度<135 mEq/L）。与血钠正常的患者（135 - 144 mEq/L）相比，低钠血症患者年龄更大（67.0岁对63.1岁，P <.001），合并症更多（平均Deyo - Charlson指数1.9对1.4，P <.001）。在多变量调整模型中，低钠血症患者住院期间死亡风险增加（比值比1.47，95%置信区间[CI]，1.33 - 1.62），1年时（风险比1.38，95% CI，1.32 - 1.46），5年时（风险比1.25，95% CI，1.21 - 1.30）。即使是轻度低钠血症（130 - 134 mEq/L）患者，死亡风险也明显增加（比值比1.37，95% CI，1.23 - 1.52）。低钠血症与死亡率之间的关系在因心血管疾病、转移性癌症入院的患者以及因肌肉骨骼系统相关手术入院的患者中尤为明显。住院期间低钠血症得到纠正可降低低钠血症所致的死亡风险增加。
低钠血症，即使是轻度的，也与死亡率增加相关。
