Güçyetmez B, Ayyildiz A C, Ogan A, Guder B Y, Özçobanoğlu S, Ayyildiz A, Çakar N, Telci L
Intensive Care Unit, International Hospital, Istanbul, Turkey -
Minerva Anestesiol. 2014 Oct;80(10):1096-104. Epub 2014 Jan 9.
Dysnatremia present at the time of intensive care unit (ICU) admission is associated with mortality. In this study, we investigated the epidemiology of dysnatremia present on ICU admission and the impact of organ dysfunction on the association between dysnatremia and mortality. We hypothesized that dysnatremia comorbid with organ dysfunction is associated with higher risk of mortality.
This retrospective study was conducted on all patients admitted to the International Hospital General ICU in Istanbul over a period of 6 years (2006-2011). Patients were classified, according to the most abnormal serum sodium values measured within 24 hours after ICU admission, into 7 groups as follows: normonatremia (135≤Na≤145 mmol/L), borderline hyponatremia (130≤Na<135 mmol/L), mild hyponatremia (125≤Na<130 mmol/L), severe hyponatremia (Na <125 mmol/L), borderline hypernatremia (145<Na≤150 mmol/L), mild hypernatremia (150<Na≤155 mmol/L), and severe hypernatremia (Na >155 mmol/L).
The total admitting patient were 1657. A total of 1060 patients' data were analyzed in this study. Sodium levels were normal in 637 (60.1%), hyponatremic in 367 (34.6%) and hypernatremic in 56 (5.3%) patients. Multivariate analysis showed that only SAPS II was associated with increased mortality (OR, 1.05 [95% confidence interval, 1.02-1.09]). The odds ratio (95% CI) of dysnatremia (Na <125 mmol/L and >150 mmol/L) for mortality was 4.37 (2.29-8.36) in patients with organ dysfunction (number of dysfunctional organs ≥1) (P<0.001).
Below 125 and above 150 mmol/L sodium levels at ICU admission are risk factors for higher mortality rates in patients with comorbid organ dysfunction. The effect of dysnatremia on mortality is observed when organ dysfunction is present.
重症监护病房（ICU）入院时出现的血钠异常与死亡率相关。在本研究中，我们调查了ICU入院时血钠异常的流行病学情况以及器官功能障碍对血钠异常与死亡率之间关联的影响。我们假设合并器官功能障碍的血钠异常与更高的死亡风险相关。
本回顾性研究对伊斯坦布尔国际医院综合ICU在6年期间（2006 - 2011年）收治的所有患者进行。根据ICU入院后24小时内测得的最异常血清钠值，将患者分为以下7组：血钠正常（135≤Na≤145 mmol/L）、临界低钠血症（130≤Na<135 mmol/L）、轻度低钠血症（125≤Na<130 mmol/L）、重度低钠血症（Na <125 mmol/L）、临界高钠血症（145<Na≤150 mmol/L）、轻度高钠血症（150<Na≤十五5 mmol/L）和重度高钠血症（Na >155 mmol/L）。
总入院患者为1657例。本研究共分析了1060例患者的数据。637例（60.1%）患者血钠水平正常，367例（34.6%）患者为低钠血症，56例（5.3%）患者为高钠血症。多因素分析显示，只有简化急性生理学评分系统（SAPS）II与死亡率增加相关（比值比[OR]，1.05[95%置信区间，1.02 - 1.09]）。在合并器官功能障碍（功能障碍器官数量≥1）的患者中，血钠异常（Na <125 mmol/L和>150 mmol/L）导致死亡的比值比（95%置信区间）为4.37（2.29 - 8.36）（P<0.001）。
ICU入院时血钠水平低于125 mmol/L和高于150 mmol/L是合并器官功能障碍患者死亡率升高的危险因素。当存在器官功能障碍时，可观察到血钠异常对死亡率的影响。
