Namdar Thomas, von Wild Tobias, Siemers Frank, Stollwerck Peter L, Stang Felix H, Mailänder Peter, Lange Thomas
Department of Plastic and Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein Campus Lübeck, Germany.
Ger Med Sci. 2010 Nov 2;8:Doc30. doi: 10.3205/000119.
In-hospital hypernatremia is associated with increased mortality rates. We want to elucidate the impact of in-hospital acquired hypernatremia in mortality of Toxic Epidermal Necrolysis (TEN).
Is there an association between hypernatremia and mortality in patients with TEN?
Retrospective study of 25 patients with TEN. Laboratory electrolyte results, diuresis and survival were analyzed. Patients were separated in two groups without (Group A) or with (Group B) hypernatremia.
In Group A 10 patients with a TBSA of 74 ± 25% (mean ± standard deviation), and a SCORTEN-Score of 2.7 ± 0.9 were summarized. Diuresis within the first 10 days after admission was 1 ± 0.3 ml/kg/hour. In Group B 15 patients with a TBSA of 76 ± 19%, and a SCORTEN-Score of 3.5 ± 1 were included. Diuresis within the first 10 days after admission was 1.4 ± 0.4 ml/kg/hour. Hypernatremia occurred on day 3.3 ± 2.4 after admission and persisted for 5.3 ± 2.9 days. Statistical analysis showed a significantly higher diuresis (p=0.007) and SCORTEN-Score (p=0.04) in the hypernatremic patients. One normonatremic and 8 hypernatremic patients died during ICU-stay (overall mortality rate 36%). A significantly higher mortality rate was found in Group B (odds ratio: 13,5; 95% confidence interval: 1.34-135.98; p=0.01) during ICU-stay.
TEN patients with an in-hospital acquired hypernatremia have an increased mortality risk. Close electrolyte monitoring is advisable in these patients.
医院内高钠血症与死亡率增加相关。我们想要阐明医院获得性高钠血症对中毒性表皮坏死松解症（TEN）死亡率的影响。
TEN患者的高钠血症与死亡率之间是否存在关联？
对25例TEN患者进行回顾性研究。分析实验室电解质结果、尿量及生存率。患者被分为两组，无高钠血症组（A组）和有高钠血症组（B组）。
A组总结了10例患者，其体表面积（TBSA）为74±25%（均值±标准差），SCORTEN评分2.7±0.9。入院后前10天的尿量为1±0.3毫升/千克/小时。B组纳入了15例患者，TBSA为76±19%，SCORTEN评分为3.5±1。入院后前10天的尿量为1.4±0.4毫升/千克/小时。高钠血症在入院后3.3±2.4天出现，并持续5.3±2.9天。统计分析显示，高钠血症患者的尿量（p=0.007）和SCORTEN评分（p=0.04）显著更高。1例血钠正常患者和8例高钠血症患者在重症监护病房（ICU）住院期间死亡（总死亡率36%）。ICU住院期间B组的死亡率显著更高（比值比：13.5；95%置信区间：1.34 - 135.98；p=0.01）。
医院获得性高钠血症的TEN患者死亡风险增加。建议对这些患者进行密切的电解质监测。
