白蛋白在肝硬化住院患者低钠血症纠正中的作用。
The Impact of Albumin Use on Resolution of Hyponatremia in Hospitalized Patients With Cirrhosis.
机构信息
Virginia Commonwealth university and McGuire VA Medical Center, Richmond, VA, uSA. university of Alberta, Edmonton, AB, Canada. Dallas VA Medical Center and Baylor University Medical Center, Dallas, TX, USA. University of Washington, Seattle, WA, USA. University of Denver, Colorado, CO, USA. University of Toronto, Toronto, ON, Canada. Mayo Clinic, Rochester, MN, USA. Yale University Medical Center, West Haven, CT, USA. University of Tennessee, Memphis, TN, USA. University of Rochester, Rochester, NY, USA. University of California, San Francisco, CA, USA. University of Arizona, Phoenix, AZ, USA. University of Texas, Houston, TX, USA. Mercy Medical Center, Baltimore, MD, USA. Mayo Clinic, Scottsdale, AZ, USA. Emory University Medical Center, Atlanta, GA, USA. University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Am J Gastroenterol. 2018 Sep;113(9):1339. doi: 10.1038/s41395-018-0119-3. Epub 2018 Jun 8.
OBJECTIVES
Hyponatremia is associated with poor outcomes in cirrhosis independent of MELD. While intravenous albumin has been used in small series, its role in hyponatremia is unclear. The aim of this study is to determine the effect of albumin therapy on hyponatremia.
METHODS
Hospitalized cirrhotic patients included in the NACSELD (North American Consortium for End-Stage Liver Disease) cohort with hyponatremia (Na <130mmol/L) were divided into those receiving intravenous albumin or not. Determinants of hyponatremia resolution (Na ≥135 meq/L) and 30-day survival were analyzed using regression and ANCOVA models.
RESULTS
Overall, 2435 patients, of whom 1126 had admission hyponatremia, were included. Of these, 777 received 225 (IQR 100,400) g of albumin, while 349 did not. Patients given albumin had a higher admission MELD score, and serum creatinine and lower admission Na and mean arterial pressure (MAP). However they experienced a higher maximum Na and hyponatremia resolution (69% vs 61%, p = 0.008) compared to those who did not. On regression, delta Na was independently associated with admission creatinine, MAP and albumin use. On ANCOVA with logistic regression, there was a significant difference in hyponatremia resolution between those who did or did not receive albumin, even after adjustment for admission Na and GFR (85.41% vs 44.78%, p = 0.0057, OR: 1.50 95% CI: 1.13-2.00). Independent predictors of 30-day survival were hyponatremia resolution, age, ACLF, and admission GFR.
CONCLUSION
Hospitalized patients with cirrhosis and hyponatremia who received intravenous albumin had a higher rate of hyponatremia resolution independent of renal function and baseline sodium levels, which was in turn associated with a better 30-day survival.
目的
低钠血症与肝硬化患者的不良预后相关，且独立于 MELD 评分。虽然已有小系列研究使用静脉白蛋白，但白蛋白在低钠血症中的作用尚不清楚。本研究旨在确定白蛋白治疗对低钠血症的影响。
方法
将纳入 NACSELD（北美终末期肝病联盟）队列的住院肝硬化患者中合并低钠血症（Na<130mmol/L）的患者分为接受或未接受静脉白蛋白治疗的两组。使用回归和协方差分析模型分析低钠血症缓解（Na≥135meq/L）和 30 天生存率的决定因素。
结果
共纳入 2435 例患者，其中 1126 例入院时存在低钠血症。其中，777 例患者接受了 225（IQR 100,400）g 白蛋白，349 例患者未接受白蛋白治疗。接受白蛋白治疗的患者入院时 MELD 评分更高，血清肌酐水平更低，入院时 Na 和平均动脉压（MAP）水平更低。然而，与未接受白蛋白治疗的患者相比，接受白蛋白治疗的患者最大 Na 值更高，低钠血症缓解率更高（69%比 61%，p=0.008）。回归分析显示，Na 差值与入院时肌酐、MAP 和白蛋白使用独立相关。协方差分析和逻辑回归显示，即使在调整入院 Na 和肾小球滤过率（GFR）后，接受或不接受白蛋白治疗的患者在低钠血症缓解方面仍存在显著差异（85.41%比 44.78%，p=0.0057，OR：1.50，95%CI：1.13-2.00）。30 天生存率的独立预测因素为低钠血症缓解、年龄、ACLF 和入院时 GFR。
结论
住院肝硬化合并低钠血症的患者接受静脉白蛋白治疗后，低钠血症缓解率更高，独立于肾功能和基线 Na 水平，而低钠血症缓解与 30 天生存率提高相关。
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