Sen Soman, Tran Nam, Chan Brian, Palmieri Tina L, Greenhalgh David G, Cho Kiho
Department of Surgery, Division of Burn Surgery, University of California Davis, 2425 Stockton Blvd. Suite 718, Sacramento, CA 95817 USA.
Burns Trauma. 2017 Nov 6;5:34. doi: 10.1186/s41038-017-0098-4. eCollection 2017.
Dysnatremias are associated with increased mortality in critically ill patients. Hypernatremia in burn patients is also associated with poor survival. Based on these findings, we hypothesized that high plasma sodium variability is a marker for increased mortality in severely burn-injured patients.
We performed a retrospective review of adult burn patients with a burn injury of 15% total body surface area (TBSA) or greater from 2010 to 2014. All patients included in the study had at least three serum sodium levels checked during admission. We used multivariate logistic regression analysis to determine if hypernatremia, hyponatremia, or sodium variability independently increased the odds ratio (OR) for death.
Two hundred twelve patients met entry criteria. Mean age and %TBSA for the study was 45 ± 18 years and 32 ± 19%. Twenty-nine patients died for a mortality rate of 14%. Serum sodium was measured 10,310 times overall. The median number of serum sodium measurements per patient was 22. Non-survivors were older (59 ± 19 vs. 42 ± 16 years) and suffered from a more severe burn injury (50 ± 25% vs. 29 ± 16%TBSA). While mean sodium was significantly higher for non-survivors (138 ± 3 milliequivalents/liter (meq/l)) than for survivors (135 ± 2 meq/l), mean sodium levels remained within the laboratory reference range (135 to 145 meq/l) for both groups. Non-survivors had a significantly higher median number of hypernatremic (> 145 meq/l) measurements (2 vs. 0). Coefficient of variation (CV) was significantly higher in non-survivors (2.85 ± 1.1) than survivors (2.0 ± 0.7). Adjusting for TBSA, age, ventilator days, and intensive care unit (ICU) stay, a higher CV of sodium measurements was associated with mortality (OR 5.8 (95% confidence interval (CI) 1.5 to 22)). Additionally, large variation in sodium ranges in the first 10 days of admission may be associated with increased mortality (OR 1.35 (95% CI 1.06 to1.7)).
Increased variability in plasma sodium may be associated with death in severely burned patients.
血钠异常与危重症患者死亡率增加相关。烧伤患者的高钠血症也与生存率低相关。基于这些发现，我们推测高血浆钠变异性是严重烧伤患者死亡率增加的一个指标。
我们对2010年至2014年烧伤总面积达15%或更高的成年烧伤患者进行了一项回顾性研究。纳入研究的所有患者在入院期间至少检查了三次血清钠水平。我们使用多因素逻辑回归分析来确定高钠血症、低钠血症或钠变异性是否独立增加死亡比值比（OR）。
212例患者符合入选标准。该研究的平均年龄和烧伤总面积分别为45±18岁和32±19%。29例患者死亡，死亡率为14%。总共测量血清钠10310次。每位患者血清钠测量的中位数为22次。非幸存者年龄更大（59±19岁 vs. 42±16岁），烧伤更严重（50±25% vs. 29±16%TBSA）。虽然非幸存者的平均钠水平（138±3毫当量/升（meq/l））显著高于幸存者（135±2 meq/l），但两组的平均钠水平均保持在实验室参考范围内（135至145 meq/l）。非幸存者高钠血症（>145 meq/l）测量的中位数显著更高（2次 vs. 0次）。非幸存者的变异系数（CV）（2.85±1.1）显著高于幸存者（2.0±0.7）。校正烧伤总面积、年龄、呼吸机使用天数和重症监护病房（ICU）住院时间后，较高的血清钠测量CV与死亡率相关（OR 5.8（95%置信区间（CI）1.5至22））。此外，入院后前10天钠范围的较大变化可能与死亡率增加相关（OR 1.35（95%CI 1.06至1.7））。
血浆钠变异性增加可能与严重烧伤患者的死亡相关。
