Zieschang Tania, Wolf Marcia, Vellappallil Tinu, Uhlmann Lorenz, Oster Peter, Kopf Daniel
Geriatric Centre at the University of Heidelberg, Agaplesion Bethanien Hospital Heidelberg; SLK-Kliniken Heilbronn GmbH; Department of Anesthesiology and Intensive Care, Evangelische Diakonissenanstalt Karlsruhe-Rüppurr; Institute for Medical Biometry and Informatics (IMBI), University of Heidelberg; Geriatric Hospital, Katholisches Marienkrankenhaus Hamburg, gGmbH.
Dtsch Arztebl Int. 2016 Dec 16;113(50):855-862. doi: 10.3238/arztebl.2016.0855.
Hyponatremia and delirium are frequent problems in older hospitalized patients. Although confusional states are considered to be a possible complication of hyponatremia, there has been no systematic study to date of the precise prevalence of delirium among patients with hyponatremia and its effect on long-term outcomes.
In a 13-month period in 2009/2010, all patients with a serum sodium level less than or equal to 130 mmol/L (the hyponatremia group) in a cohort of hospitalized older patients were studied and compared to a normonatremic control group of patients who were matched for age, sex, and diagnosis group. The prevalence of delirium was determined by two-stage examination. Inhospital mortality, mortality six months after initial examination, and functional status were prospectively analyzed.
179 patients were identified whose serum sodium level was less than or equal to 130 mmol/L (7.9% of all treated patients), of whom 141 were included in the hyponatremia group. The mean age of the participants was 83 (range, 63-102), and 84% were women. Patients with hyponatremia suffered more often from delirium (22.7% versus 8.5%; p = 0.002) and had a higher inhospital mortality (10.6% versus 2.1%; p = 0.005). The mortality six months after initial examination was 31.9% versus 22.7% (p = 0.080). 59.7% of patients in the hyponatremia group and 49% in the control group (p = 0.146) needed a higher level of chronic care after discharge than they had needed before the hospitalization.
Hyponatremia in hospitalized older patients is associated with a higher likelihood of delirium and an elevated in-hospital mortality.
低钠血症和谵妄是老年住院患者常见的问题。尽管意识混乱状态被认为是低钠血症的一种可能并发症，但迄今为止，尚无关于低钠血症患者中谵妄的确切患病率及其对长期预后影响的系统研究。
在2009/2010年的13个月期间，对一组老年住院患者中所有血清钠水平小于或等于130 mmol/L的患者（低钠血症组）进行研究，并与年龄、性别和诊断组相匹配的正常血钠对照组进行比较。谵妄的患病率通过两阶段检查确定。对住院死亡率、初次检查后6个月的死亡率和功能状态进行前瞻性分析。
确定了179例血清钠水平小于或等于130 mmol/L的患者（占所有接受治疗患者的7.9%），其中141例纳入低钠血症组。参与者的平均年龄为83岁（范围63 - 102岁），84%为女性。低钠血症患者谵妄的发生率更高（22.7%对8.5%；p = 0.002），住院死亡率也更高（10.6%对2.1%；p = 0.005）。初次检查后6个月的死亡率为31.9%对22.7%（p = 0.080）。低钠血症组59.7%的患者和对照组49%的患者（p = 0.146）出院后需要比住院前更高水平的长期护理。
老年住院患者的低钠血症与谵妄的较高发生率和住院死亡率升高相关。
