Liber Michal, Sonnenblick Moshe, Munter Gabriel
Endocr Pract. 2016 Dec;22(12):1429-1435. doi: 10.4158/EP161240.OR. Epub 2016 Sep 15.
Elderly patients have a high prevalence of hypernatremia. The aim of this study was to determine demographic and clinical characteristics of the elderly hypernatremic patient hospitalized in the internal medicine ward and to enhance understanding of the role of antidiuretic hormone (ADH) secretion in the pathogenesis of hypernatremia.
Case-control study performed in an internal medicine ward in a university-affiliated hospital. Thirtythree elderly hypernatremic patients (admission sodium, >150 mEq/L; age, >70 years) were compared with 34 normonatremic patients. Demographic, functional (mental status and activities of daily living), clinical data (Acute Physiology and Chronic Health Evaluation [APACHE] II score), and serum copeptin levels as a marker of ADH secretion, were collected at admission. Mortality and change in the functional status were followed up to 30 days from discharge.
Patients with hypernatremia presented with significantly lower baseline functional and cognitive states and higher APACHE II score (21.3 ± 8.6 vs. 15.4 ± 6.7; P<.01). Mortality within 30 days after discharge was higher in the hypernatremic group (58% vs. 32%; P<.05). Higher copeptin levels were found in the hypernatremic group compared to the normonatremic group (100.2 ± 60.6 pmol/L vs. 66.5 ± 57.2 pmol/L; P<.05). High levels of copeptin were associated with higher in-hospital (P<.05) and 30-day (P<.01) mortality. Sodium levels were found correlated with copeptin levels; yet, an even stronger correlation was found between copeptin levels and APACHE II score (r = 0.52; P<.001).
Hypernatremia in the elderly at admission is associated with a high mortality rate. Copeptin level in the elderly seems to be a good single disease severity marker. ADH is strongly secreted in elderly hypernatremic patients.
ADH = antidiuretic hormone APACHE = Acute Physiology and Chronic Health Evaluation.
老年患者高钠血症患病率较高。本研究旨在确定在内科病房住院的老年高钠血症患者的人口统计学和临床特征，并加深对抗利尿激素（ADH）分泌在高钠血症发病机制中作用的理解。
在一所大学附属医院的内科病房进行病例对照研究。将33例老年高钠血症患者（入院时血钠>150 mEq/L；年龄>70岁）与34例血钠正常的患者进行比较。入院时收集人口统计学、功能（精神状态和日常生活活动能力）、临床数据（急性生理与慢性健康状况评估[APACHE]II评分）以及作为ADH分泌标志物的血清 copeptin 水平。随访出院后30天内的死亡率和功能状态变化。
高钠血症患者的基线功能和认知状态显著较低，APACHE II评分较高（21.3±8.6对15.4±6.7；P<.01）。高钠血症组出院后30天内的死亡率较高（58%对32%；P<.05）。与血钠正常组相比，高钠血症组的 copeptin 水平更高（100.2±60.6 pmol/L对66.5±57.2 pmol/L；P<.05）。高 copeptin 水平与较高的住院死亡率（P<.05）和30天死亡率（P<.01）相关。发现血钠水平与 copeptin 水平相关；然而，copeptin 水平与 APACHE II评分之间的相关性更强（r = 0.52；P<.001）。
入院时老年患者的高钠血症与高死亡率相关。老年人的 copeptin 水平似乎是一个良好的单一疾病严重程度标志物。老年高钠血症患者抗利尿激素分泌强烈。
ADH = 抗利尿激素；APACHE = 急性生理与慢性健康状况评估
