Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique Drépanocytose Recherche à Paris Sorbonne Université, Sorbonne University, Paris, France.
Department of Information Systems, Assistance Publique-Hôpitaux de Paris, Paris, France.
Am J Med. 2020 Sep;133(9):e465-e482. doi: 10.1016/j.amjmed.2020.02.017. Epub 2020 Mar 19.
Low plasma sodium concentration has been recognized as a prognostic factor in several disorders but never evaluated in sickle cell disease. The present study evaluates its value at admission to predict a complication in adult patients with sickle cell disease hospitalized for an initially uncomplicated acute painful episode.
The primary outcome of this retrospective study, performed between 2010 and 2015 in a French referral center for sickle cell disease, was a composite criterion including acute chest syndrome, intensive care unit transfer, red blood cell transfusion or inpatient death. Analyses were adjusted for age, sex, hemoglobin genotype and concentration, lactate dehydrogenase (LDH) concentration, and white blood cell count.
We included 1218 stays (406 patients). No inpatient death occurred during the study period. Hyponatremia (plasma sodium ≤135 mmol/L) at admission in the center was associated with the primary outcome (adjusted odds ratio [OR] 1.95, 95% confidence interval [CI] 1.3-2.91, P = 0.001), with acute chest syndrome (OR 1.95 [95% CI 1.2-3.17, P = 0.008]), and red blood cell transfusion (OR 2.71 [95% CI 1.58-4.65, P <0.001]) but not significantly with intensive care unit transfer (OR 1.83 [95% CI 0.94-3.79, P = 0.074]). Adjusted mean length of stay was longer by 1.1 days (95% CI 0.5-1.6, P <0.001) in patients with hyponatremia at admission.
Hyponatremia at admission in the medical department for an acute painful episode is a strong and independent prognostic factor of unfavorable outcome and, notably, acute chest syndrome. It could help targeting patients who may benefit from closer monitoring.
低血浆钠离子浓度已被认为是几种疾病的预后因素，但从未在镰状细胞病中进行过评估。本研究评估其入院时的价值，以预测因最初无并发症的急性疼痛发作而住院的镰状细胞病成年患者的并发症。
这是一项回顾性研究，于 2010 年至 2015 年在法国镰状细胞病转诊中心进行，主要结局是包括急性胸痛综合征、重症监护病房转科、红细胞输血或住院期间死亡在内的复合标准。分析调整了年龄、性别、血红蛋白基因型和浓度、乳酸脱氢酶（LDH）浓度和白细胞计数。
我们纳入了 1218 次住院（406 例患者）。研究期间无住院期间死亡。中心入院时的低钠血症（血浆钠≤135mmol/L）与主要结局相关（校正比值比[OR]1.95，95%置信区间[CI]1.3-2.91，P=0.001），与急性胸痛综合征（OR 1.95[95%CI 1.2-3.17，P=0.008]）和红细胞输血（OR 2.71[95%CI 1.58-4.65，P<0.001]）相关，但与重症监护病房转科无显著相关性（OR 1.83[95%CI 0.94-3.79，P=0.074]）。入院时低钠血症患者的调整平均住院时间延长了 1.1 天（95%CI 0.5-1.6，P<0.001）。
急性疼痛发作时在医疗部门入院时出现低钠血症是不良预后的一个强烈且独立的预后因素，特别是急性胸痛综合征。它可以帮助确定可能受益于更密切监测的患者。
