Gandhi Sonja, McArthur Eric, Mamdani Muhammad M, Hackam Daniel G, McLachlan Richard S, Weir Matthew A, Burneo Jorge G, Garg Amit X
Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
Epilepsia. 2016 Dec;57(12):2067-2079. doi: 10.1111/epi.13593. Epub 2016 Nov 29.
To examine the 30-day risk of hospitalization with hyponatremia associated with carbamazepine, valproic acid (V), phenytoin (P), or topiramate (T) use compared to nonuse in the outpatient setting among older adults.
We conducted two population-based, retrospective cohort studies in Ontario, Canada, between 2003 and 2015 using administrative health care databases of older adults. The first study compared carbamazepine users to a propensity-score matched group of antiepileptic drug nonusers, whereas the second compared V-P-T users to a propensity-score matched group of antiepileptic nonusers. The primary outcome was hospitalization with hyponatremia within 30 days of an antiepileptic prescription.
The baseline characteristics between matched groups were similar in both cohorts. Carbamazepine use versus nonuse was associated with a higher 30-day risk of hospitalization with hyponatremia (82/21,191 [0.39%] versus 30/63,573 [0.05%]; relative risk [RR] 8.20, 95% confidence interval [CI] 5.40-12.46). Similarly, V-P-T use versus nonuse was associated with a higher 30-day risk of hospitalization with hyponatremia (34/20,155 [0.17%] versus 26/40,310 [0.06%]; RR 2.62, 95% CI 1.57-4.36).
Older adults prescribed carbamazepine and V-P-T have a higher risk of being hospitalized with hyponatremia compared to other adults with similar indicators of baseline health who were not prescribed antiepileptic drugs. Physicians should be mindful of this risk; when a patient presents to a hospital with symptomatic hyponatremia these drugs should be considered as potential causes.
在门诊环境中，比较老年患者使用卡马西平、丙戊酸（V）、苯妥英（P）或托吡酯（T）与未使用这些药物时发生低钠血症并住院的30天风险。
2003年至2015年期间，我们在加拿大安大略省利用老年人行政医疗保健数据库开展了两项基于人群的回顾性队列研究。第一项研究将卡马西平使用者与倾向评分匹配的抗癫痫药物未使用者组进行比较，而第二项研究将V-P-T使用者与倾向评分匹配的抗癫痫药物未使用者组进行比较。主要结局是抗癫痫药物处方开具后30天内因低钠血症住院。
两个队列中匹配组之间的基线特征相似。使用卡马西平与未使用相比，发生低钠血症并住院的30天风险更高（82/21,191 [0.39%] 对比30/63,573 [0.05%]；相对风险 [RR] 8.20，95% 置信区间 [CI] 5.40 - 12.46）。同样，使用V-P-T与未使用相比，发生低钠血症并住院的30天风险更高（34/20,155 [0.17%] 对比26/40,310 [0.06%]；RR 2.62，95% CI 1.57 - 4.36）。
与未开具抗癫痫药物、具有相似基线健康指标的其他成年人相比，开具卡马西平及V-P-T的老年人发生低钠血症并住院的风险更高。医生应留意这一风险；当患者因症状性低钠血症入院时，应将这些药物视为潜在病因。
