Medical Intensive Care Unit, Saint-Louis University Hospital, APHP, 1 Avenue Claude Vellefaux, Paris, France.
Nephrol Dial Transplant. 2010 Aug;25(8):2510-5. doi: 10.1093/ndt/gfq067. Epub 2010 Feb 17.
The aim of this study is to describe the prevalence and outcomes of intensive care unit (ICU)-acquired hypernatraemia (IAH).
A retrospective analysis was performed on a prospectively collected database fed by 12 ICUs. Subjects are unselected patients with ICU stay >48 h. Mild and moderate to severe hypernatraemia were defined as serum sodium >145 and >150 mmol/L, respectively. IAH was hypernatraemia occurring >or=24 h after ICU admission in patients with normal serum sodium at ICU admission.
Of the 8441 patients, 301 were excluded because they had hypernatraemia at ICU admission. Of the remaining 8140 patients, 901 (11.1%) experienced mild hypernatraemia, and 344 (4.2%) experienced moderate to severe hypernatraemia. Factors independently associated with IAH were male gender, severity at admission as assessed by the Simplified Acute Physiology Score version II (SAPS II), and organ failure or life-supporting treatment at ICU admission. Unadjusted hospital mortality was 15.2% in patients without hypernatraemia compared to 29.5% in patients with mild IAH and 46.2% in those with moderate to severe IAH (P < 0.0001). When any degree of IAH was handled as a time-dependent variable in a subdistribution hazard model, the subdistribution hazard ratio (SHR) for ICU mortality was 4.26 [95% confidence interval (CI), 3.74-4.84]. After stratification by centre and adjustment for confounders, both mild IAH and moderate to severe IAH were independently associated with mortality [SHR 2.03 (95% CI 1.73-2.39) and 2.67 (95% CI 2.19-3.26), respectively].
IAH is frequent and associated with mortality after adjustment on severity at ICU admission.
本研究旨在描述重症监护病房（ICU）获得性高钠血症（IAH）的患病率和结局。
对通过 12 个 ICU 收集的前瞻性数据库进行回顾性分析。研究对象为 ICU 入住时间超过 48 小时的非选择性患者。轻度和中重度高钠血症分别定义为血清钠>145mmol/L 和>150mmol/L。IAH 是指 ICU 入院时血清钠正常的患者在 ICU 入院后>24 小时发生的高钠血症。
在 8441 名患者中，有 301 名因 ICU 入院时伴有高钠血症而被排除。在剩余的 8140 名患者中，901 名（11.1%）出现轻度高钠血症，344 名（4.2%）出现中重度高钠血症。与 IAH 相关的独立因素包括男性、入院时简化急性生理学评分 II 版（SAPS II）评估的严重程度，以及入院时器官衰竭或生命支持治疗。无高钠血症患者的住院死亡率为 15.2%，轻度 IAH 患者为 29.5%，中重度 IAH 患者为 46.2%（P<0.0001）。当任何程度的 IAH 作为亚分布风险模型中的时间依赖性变量时，ICU 死亡率的亚分布风险比（SHR）为 4.26[95%置信区间（CI），3.74-4.84]。在按中心分层并调整混杂因素后，轻度 IAH 和中重度 IAH 均与死亡率独立相关[SHR 分别为 2.03（95%CI 1.73-2.39）和 2.67（95%CI 2.19-3.26）]。
IAH 很常见，并且与 ICU 入院时严重程度调整后的死亡率相关。
