住院患者严重低钠血症的实验室评估不足与不良临床结局相关。

Lack of laboratory assessment of severe hyponatraemia is associated with detrimental clinical outcomes in hospitalised patients.

机构信息

Department of Diabetes and Endocrinology, University Hospital Lewisham, London, UK.

出版信息

Int J Clin Pract. 2009 Oct;63(10):1451-5. doi: 10.1111/j.1742-1241.2009.02037.x.

DOI:10.1111/j.1742-1241.2009.02037.x

PMID:19769701

Abstract

OBJECTIVE

Increased mortality with severe hyponatraemia is well known. What is less clear is the mortality risk according to the pattern of the developing hyponatraemia and whether this may be affected by the intervention of the clinician.

METHODS

From our laboratory database, we retrospectively collected data of a 12-month period of adult patients with severe hyponatraemia (< or = 120 mmol/l). One hundred and thirteen patients were identified. Normonatraemic controls (n = 113) were identified by plasma sodium of 135 mmol/l over the same period, and whose nadir during hospitalisation was > or = 130 mmol/l. Results are mean +/- SD unless stated otherwise. Duration of hospitalisation and clinical outcomes was confirmed from hospital records.

RESULTS

The mean nadir plasma sodium of the hyponatraemic group was 116.0 +/- 4.4 mmol/l and 134.0 +/- 2.8 mmol/l in controls. Although the hyponatraemic patients were younger than controls (65.8 +/- 18.4 vs. 72.3 +/- 14.9 years; p = 0.004), they had higher mortality (24 vs. 7, p = 0.002) and longer hospitalisation than controls: median (IQR), 12 (7-22) vs. 7 (3-16.5) days (p < 0.001). A total of 55 patients developed severe hyponatraemia following admission. This subgroup comprised a higher proportion of surgical patients (23.6% vs. 1.7%, p < 0.001) than those with severe hyponatraemia on admission. Furthermore, both mortality (n = 17 vs. n = 7; p = 0.02) and duration of hospitalisation, median 19 days (IQR 10-35) vs. 9.5 (5-15) days (p < 0.001), were greater. Failure to measure plasma and urinary osmolalities was associated with increased mortality.

CONCLUSIONS

Severe hyponatraemia is associated with prolonged admission and increased mortality compared with normonatraemic patients. Progressive hyponatraemia following admission incurs a higher risk of death. This may represent illness-severity, inappropriate management or inadequate investigation.

摘要

目的

严重低钠血症伴死亡率增加是众所周知的。但发展性低钠血症的死亡率风险以及临床医生的干预是否会对此产生影响尚不清楚。

方法

我们从实验室数据库中回顾性收集了 12 个月期间患有严重低钠血症（<或=120mmol/l）的成年患者的数据。共确定了 113 名患者。同期血浆钠浓度为 135mmol/l 的正常钠血症对照者（n=113），且住院期间的最低值>或=130mmol/l。除非另有说明，否则结果均为平均值±标准差。住院时间和临床结局均从住院病历中确认。

结果

低钠血症组的平均最低血浆钠浓度为 116.0±4.4mmol/l，对照组为 134.0±2.8mmol/l。尽管低钠血症组患者比对照组年轻（65.8±18.4 vs. 72.3±14.9 岁；p=0.004），但死亡率更高（24 比 7，p=0.002），且住院时间长于对照组：中位数（IQR），12（7-22）比 7（3-16.5）天（p<0.001）。共有 55 名患者在入院后发生严重低钠血症。该亚组中手术患者的比例高于入院时即伴有严重低钠血症的患者（23.6%比 1.7%，p<0.001）。此外，死亡率（n=17 比 n=7；p=0.02）和住院时间均更长，中位数 19 天（IQR 10-35）比 9.5（5-15）天（p<0.001）。未能测量血浆和尿渗透压与死亡率增加有关。