Wald Ron, Jaber Bertrand L, Price Lori Lyn, Upadhyay Ashish, Madias Nicolaos E
St Michael's Hospital and University of Toronto, and Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
Arch Intern Med. 2010 Feb 8;170(3):294-302. doi: 10.1001/archinternmed.2009.513.
Hyponatremia is the most common electrolyte disorder encountered in hospitalized patients.
We evaluated whether hospital-associated hyponatremia has an independent effect on all-cause mortality, hospital length of stay (LOS), and patient disposition. This cohort study included all adult hospitalizations at an academic medical center occurring between 2000-2007 for which an admission serum sodium concentration ([Na(+)]) was available (N = 53 236). We examined community-acquired hyponatremia (admission serum [Na(+)], <138 mEq/L [to convert to millimoles per liter, multiply by 1.0]), hospital-aggravated hyponatremia (community-acquired hyponatremia complicated by worsening in serum [Na(+)]), and hospital-acquired hyponatremia (nadir serum [Na(+)], <138 mEq/L with a normal admission serum [Na(+)]). The independent associations of these hyponatremic presentations with in-hospital mortality, LOS, and patient disposition were evaluated using generalized estimating equations adjusted for age, sex, race, admission service, and Deyo-Charlson Comorbidity Index score.
Community-acquired hyponatremia occurred in 37.9% of hospitalizations and was associated with adjusted odds ratios (ORs) of 1.52 (95% confidence interval [CI], 1.36-1.69) for in-hospital mortality and 1.12 (95% CI, 1.08-1.17) for discharge to a short- or long-term care facility and a 14% (95% CI, 11%-16%) adjusted increase in LOS. Hospital-acquired hyponatremia developed in 38.2% of hospitalizations longer than 1 day in which initial serum [Na(+)] was 138 to 142 mEq/L. Hospital-acquired hyponatremia was associated with adjusted ORs of 1.66 (95% CI, 1.39-1.98) for in-hospital mortality and 1.64 (95% CI, 1.55-1.74) for discharge to a facility and a 64% (95% CI, 60%-68%) adjusted increase in LOS. The strength of these associations tended to increase with hyponatremia severity.
Hospital-associated hyponatremia is a common occurrence. All forms of hyponatremia are independently associated with in-hospital mortality and heightened resource consumption.
低钠血症是住院患者中最常见的电解质紊乱。
我们评估了医院相关性低钠血症对全因死亡率、住院时间（LOS）和患者出院去向是否具有独立影响。这项队列研究纳入了2000年至2007年间在一所学术医疗中心发生的所有成年住院病例，这些病例有入院时的血清钠浓度（[Na⁺]）数据（N = 53236）。我们研究了社区获得性低钠血症（入院血清[Na⁺] < 138 mEq/L [换算为毫摩尔每升时，乘以1.0]）、医院加重性低钠血症（社区获得性低钠血症合并血清[Na⁺]恶化）以及医院获得性低钠血症（最低血清[Na⁺] < 138 mEq/L且入院血清[Na⁺]正常）。使用广义估计方程评估这些低钠血症表现与住院死亡率、LOS和患者出院去向之间的独立关联，并对年龄、性别、种族、入院科室和Deyo - Charlson合并症指数评分进行了校正。
37.9%的住院病例发生社区获得性低钠血症，其与住院死亡率的校正比值比（OR）为1.52（95%置信区间[CI]，1.36 - 1.69），与出院至短期或长期护理机构的OR为1.12（95% CI，1.08 - 1.17），LOS校正后增加14%（95% CI，11% - 16%）。在初始血清[Na⁺]为138至142 mEq/L且住院时间超过1天的住院病例中，38.2%发生了医院获得性低钠血症。医院获得性低钠血症与住院死亡率的校正OR为1.66（95% CI，1.39 - 1.98），与出院至护理机构的OR为1.64（95% CI，1.55 - 1.74），LOS校正后增加64%（95% CI，60% - 68%）。这些关联的强度往往随低钠血症严重程度增加而增强。
医院相关性低钠血症很常见。所有形式的低钠血症均与住院死亡率和资源消耗增加独立相关。
