Woodman Richard J, Wood Karen M, Kunnel Aline, Dedigama Maneesha, Pegoli Matthew A, Soiza Roy L, Mangoni Arduino A
Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
Drugs Real World Outcomes. 2016 Dec;3(4):383-391. doi: 10.1007/s40801-016-0094-1.
Several drugs may lower serum sodium concentrations (NaC) in older patients. However, distinguishing their individual effects is particularly difficult in this population because of the high prevalence of polypharmacy and disease states that are per se associated with hyponatremia.
Our objective was to identify specific patterns of medication use in older hospitalized patients and determine whether these patterns were associated with serum NaC.
We collected clinical and demographic data, pre-admission drugs, Drug Burden Index (DBI) score, and average NaC during hospitalization in a consecutive series of older medical patients (n = 101, mean ± standard deviation [SD] age 87 ± 6 years). We used latent class analysis (LCA) to identify specific patterns of drug use and multivariate regression to determine the associations between 14 separate drug classes, identified patterns of drug use, and NaC.
LCA revealed three patterns: lower overall drug use (class 1), anticoagulant use and higher drug use (class 2), and antiplatelet use (class 3). Mean (±SD) DBI score in each class was 2.7 ± 1.3, 3.3 ± 1.6, and 2.4 ± 1.5, respectively (p = 0.04). Mean (± SD) NaC in classes 1, 2, and 3 were 140.6 ± 6.8, 138.7 ± 5.3, and 136.5 ± 4.7 mmol/l, respectively (p = 0.006). After adjustment for age, sex, Charlson Comorbidity Index score, estimated glomerular filtration rate (eGFR), DBI score, and digoxin use, mean NaC in class 2 and class 3 was significantly lower than in class 1 (-3.9 mmol/l; 95% confidence interval [CI] -7.1 to -0.8, p = 0.01 and -5.2 mmol/l; 95% CI -7.9 to -2.5, p < 0.001, respectively). Mean serum NaC was not significantly associated with any of the 14 individually assessed drug classes. In addition to latent class, increasing age and higher eGFR were also independently associated with lower serum NaC (p = 0.002 and p = 0.03, respectively).
LCA enabled us to identify patterns of drug use associated with lower serum NaC in older inpatients. Our results suggest that older patients using antiplatelets or anticoagulants are especially at risk of lower serum NaC.
几种药物可能会降低老年患者的血清钠浓度（NaC）。然而，由于多重用药的高发生率以及本身与低钠血症相关的疾病状态，在这一人群中区分它们各自的影响尤为困难。
我们的目的是识别老年住院患者的特定用药模式，并确定这些模式是否与血清NaC相关。
我们收集了一系列连续的老年内科患者（n = 101，平均年龄±标准差[SD]为87±6岁）的临床和人口统计学数据、入院前用药、药物负担指数（DBI）评分以及住院期间的平均NaC。我们使用潜在类别分析（LCA）来识别特定的用药模式，并使用多元回归来确定14种不同药物类别、识别出的用药模式与NaC之间的关联。
LCA揭示了三种模式：总体用药较低（第1类）、使用抗凝剂且用药较高（第2类）以及使用抗血小板药物（第3类）。每类的平均（±SD）DBI评分为2.7±1.3、3.3±×1.6和×2.4±1.5，分别（p = 0.04）。第1、2和3类的平均（±SD）NaC分别为140.6±6.8、138.7±5.3和136.5±4.7 mmol/L，分别（p = 0.006）。在调整年龄、性别、Charlson合并症指数评分、估计肾小球滤过率（eGFR）、DBI评分和地高辛使用情况后 ×，第2类和第3类的平均NaC显著低于第1类（-3.9 mmol/L；95%置信区间[CI] -7.1至-0.8，p = 0.01和-5.2 mmol/L；95% CI -7.9至-2.5，p < 0.001，分别）。平均血清NaC与单独评估的14种药物类别中的任何一种均无显著关联。除了潜在类别外，年龄增加和较高的eGFR也与较低的血清NaC独立相关（分别为p = 0.002和p = 0.03）。
LCA使我们能够识别老年住院患者中与较低血清NaC相关的用药模式。我们的结果表明，使用抗血小板药物或抗凝剂的老年患者尤其有血清NaC降低的风险。
