Marshall Dominic C, Salciccioli Justin D, Goodson Ross J, Pimentel Marco A, Sun Kristi Y, Celi Leo Anthony, Shalhoub Joseph
Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK.
Academic Foundation Program, Northeast Thames Foundation School, London, UK; Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
J Crit Care. 2017 Aug;40:63-68. doi: 10.1016/j.jcrc.2017.02.012. Epub 2017 Feb 13.
Serum sodium derangement is the most common electrolyte disturbance among patients admitted to intensive care. This study aims to validate the association between dysnatremia and serum sodium fluctuation with mortality in surgical intensive care patients.
We performed a retrospective analysis of the Medical Information Mart for Intensive Care II database. Dysnatremia was defined as a sodium concentration outside physiologic range (135-145mmol/L) and subjects were categorized by severity of dysnatremia and sodium fluctuation. Univariate and multivariable logistic regressions were used to test for associations between sodium fluctuations and mortality.
We identified 8600 subjects, 39% of whom were female, with a median age of 66years for analysis. Subjects with dysnatremia were more likely to be dead at 28 days (17% vs 7%; P<.001). There was a significant association between sodium fluctuation and mortality at 28 days (adjusted odds ratio per 1mmol/L change, 1.10 [95% confidence interval, 1.08-1.12; P<.001]), even in patients who remained normotremic during their intensive care unit stay (1.12 [95% confidence interval, 1.09-1.16; P<.001]) CONCLUSIONS: This observational study validates previous findings of an association between serum sodium fluctuations and mortality in surgical intensive care patients. This association was also present in subjects who remained normonatremic throughout their intensive care unit admission.
血清钠紊乱是重症监护病房患者中最常见的电解质紊乱。本研究旨在验证手术重症监护患者中钠血症异常与血清钠波动与死亡率之间的关联。
我们对重症监护医学信息数据库II进行了回顾性分析。钠血症异常定义为钠浓度超出生理范围（135 - 145mmol/L），并根据钠血症异常的严重程度和钠波动对受试者进行分类。使用单变量和多变量逻辑回归来检验钠波动与死亡率之间的关联。
我们确定了8600名受试者，其中39%为女性，分析的中位年龄为66岁。钠血症异常的受试者在28天时死亡的可能性更高（17%对7%；P <.001）。钠波动与28天死亡率之间存在显著关联（每1mmol/L变化的调整比值比为1.10 [95%置信区间，1.08 - 1.12；P <.001]），即使在重症监护病房住院期间保持血钠正常的患者中也是如此（1.12 [95%置信区间，1.09 - 1.16；P <.001]）。结论：这项观察性研究验证了先前关于手术重症监护患者血清钠波动与死亡率之间关联的研究结果。这种关联在整个重症监护病房住院期间血钠保持正常的受试者中也存在。
