危重症医学患者重症监护病房获得性低钠血症。
Intensive care unit-acquired hyponatremia in critically ill medical patients.
机构信息
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
出版信息
J Transl Med. 2020 Jul 2;18(1):268. doi: 10.1186/s12967-020-02443-4.
BACKGROUND
Previous research has focused on intensive care unit (ICU)-acquired hypernatremia; however, ICU-acquired hyponatremia has frequently been overlooked and has rarely been studied in surgical or mixed ICUs. The aim of this study is to investigate the incidence of ICU-acquired hyponatremia, the risk factors associated with its development, and its impact on outcomes in critically ill medical patients.
METHODS
We conducted a retrospective cohort study based on the prospective registry of all critically ill patients admitted to the medical ICU from January 2015 to December 2018. Baseline characteristics and management variables were compared between ICU-acquired hyponatremia and normonatremia patients.
RESULTS
Of 1342 patients with initial normonatremia, ICU-acquired hyponatremia developed in 217 (16.2%) patients and ICU-acquired hypernatremia developed in 117 (8.7%) patients. The Sequential Organ Failure Assessment (8.0 vs 7.0, P = 0.009) and Simplified Acute Physiology Score 3 scores (55.0 vs 51.0, P = 0.005) were higher in ICU-acquired hyponatremia patients compared with normonatremia patients. Baseline sodium (137.0 mmol/L vs 139.0 mmol/L, P < 0.001), potassium (4.2 mmol/L vs 4.0 mmol/L, P = 0.001), and creatinine (0.98 mg/dL vs 0.88 mg/dL, P = 0.034) levels were different between the two groups. Net volume balance over first 3 days was higher in ICU-acquired hyponatremia patients (19.4 mL/kg vs 11.5 mL/kg, P = 0.004) and was associated with the development of ICU-acquired hyponatremia (adjusted odds ratio, 1.004; 95% confidence interval, 1.002-1.007; P = 0.001). ICU mortality was similar in both groups (15.2% vs. 14.4%, P = 0.751), but renal replacement therapy was more commonly required in ICU-acquired hyponatremia patients (13.4% vs 7.4%, P = 0.007).
CONCLUSIONS
ICU-acquired hyponatremia is not uncommon in critically ill medical patients. Increased volume balance is associated with its development. ICU-acquired hyponatremia is related to increased use of renal replacement therapy but not to mortality.
背景
先前的研究主要集中在重症监护病房（ICU）获得性高钠血症上；然而，ICU 获得性低钠血症经常被忽视，并且在外科或混合 ICU 中很少研究。本研究旨在调查危重病医学患者 ICU 获得性低钠血症的发生率、与低钠血症发展相关的危险因素及其对结局的影响。
方法
我们进行了一项基于 2015 年 1 月至 2018 年 12 月所有入住内科重症监护病房的危重病患者的前瞻性登记的回顾性队列研究。比较 ICU 获得性低钠血症和正常钠血症患者的基线特征和治疗变量。
结果
在 1342 例初始正常钠血症患者中，217 例（16.2%）患者发生 ICU 获得性低钠血症，117 例（8.7%）患者发生 ICU 获得性高钠血症。与正常钠血症患者相比，ICU 获得性低钠血症患者的序贯器官衰竭评估（8.0 与 7.0，P=0.009）和简化急性生理学评分 3 评分（55.0 与 51.0，P=0.005）更高。两组间的基础钠（137.0mmol/L 与 139.0mmol/L，P<0.001）、钾（4.2mmol/L 与 4.0mmol/L，P=0.001）和肌酐（0.98mg/dL 与 0.88mg/dL，P=0.034）水平不同。ICU 获得性低钠血症患者第 1-3 天的净容量平衡更高（19.4mL/kg 与 11.5mL/kg，P=0.004），且与 ICU 获得性低钠血症的发生相关（校正优势比，1.004；95%置信区间，1.002-1.007；P=0.001）。两组 ICU 死亡率相似（15.2%比 14.4%，P=0.751），但 ICU 获得性低钠血症患者更常需要肾脏替代治疗（13.4%比 7.4%，P=0.007）。
结论
危重病医学患者 ICU 获得性低钠血症并不少见。容量平衡增加与低钠血症的发生相关。ICU 获得性低钠血症与肾脏替代治疗的应用增加有关，但与死亡率无关。
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