Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 14 Medyków Street, 40-752 Katowice, Poland.
Int J Environ Res Public Health. 2020 Jun 25;17(12):4573. doi: 10.3390/ijerph17124573.
Treatment with osmoactive agents such as mannitol or hypertonic saline (HTS) solutions is widely used to manage or prevent the increase of intracranial pressure (ICP) in central nervous system (CNS) disorders. We sought to evaluate the variability and mean plasma concentrations of the water and electrolyte balance parameters in critically ill patients treated with osmotic therapy and their influence on mortality. This cohort study covered patients hospitalized in an intensive care unit (ICU) from January 2017 to June 2019 with presumed increased ICP or considered to be at risk of it, treated with 15% mannitol (G1, n = 27), a combination of 15% mannitol and 10% hypertonic saline (HTS) (G2, n = 33) or 10% HTS only (G3, n = 13). Coefficients of variation (Cv) and arithmetic means (mean) were calculated for the parameters reflecting the water and electrolyte balance, i.e., sodium (NaCv/NaMean), chloride (ClCv/ClMean) and osmolality (mOsmCv/mOsmMean). In-hospital mortality was also analyzed. The study group comprised 73 individuals (36 men, 49%). Mortality was 67% (n = 49). Median NaCv (G1: = 0.002, G3: = 0.03), ClCv (G1: = 0.02, G3: = 0.04) and mOsmCv (G1: = 0.001, G3: = 0.02) were higher in deceased patients. NaMean ( = 0.004), ClMean ( = 0.04), mOsmMean ( = 0.003) were higher in deceased patients in G3. In G1: NaCv (AUC = 0.929, < 0.0001), ClCv (AUC = 0.817, = 0.0005), mOsmCv (AUC = 0.937, < 0.0001) and in G3: NaMean (AUC = 0.976, < 0.001), mOsmCv (AUC = 0.881, = 0.002), mOsmMean (AUC = 1.00, < 0.001) were the best predictors of mortality. The overall mortality prediction for combined G1+G2+G3 was very good, with AUC = 0.886 ( = 0.0002). The mortality of critically ill patients treated with osmotic agents is high. Electrolyte disequilibrium is the independent predictor of mortality regardless of the treatment method used. Variations of plasma sodium, chloride and osmolality are the most deleterious factors regardless of the absolute values of these parameters.
治疗方法采用渗透性药物，如甘露醇或高渗盐水（HTS）溶液，广泛用于治疗或预防中枢神经系统（CNS）疾病中颅内压（ICP）的升高。我们旨在评估渗透性治疗患者的水和电解质平衡参数的变异性和平均值及其对死亡率的影响。这项队列研究涵盖了 2017 年 1 月至 2019 年 6 月期间在重症监护病房（ICU）住院的患者，这些患者疑似 ICP 升高或有升高风险，接受 15%甘露醇（G1，n=27）、15%甘露醇和 10%高渗盐水（HTS）的组合（G2，n=33）或仅 10%HTS（G3，n=13）治疗。我们计算了反映水和电解质平衡的参数的变异系数（Cv）和算术平均值（mean），即钠（NaCv/NaMean）、氯（ClCv/ClMean）和渗透压（mOsmCv/mOsmMean）。还分析了院内死亡率。研究组包括 73 名患者（36 名男性，49%）。死亡率为 67%（n=49）。在死亡患者中，中位数 NaCv（G1： = 0.002，G3： = 0.03）、ClCv（G1： = 0.02，G3： = 0.04）和 mOsmCv（G1： = 0.001，G3： = 0.02）更高。在 G3 中，NaMean（ = 0.004）、ClMean（ = 0.04）和 mOsmMean（ = 0.003）在死亡患者中更高。在 G1 中：NaCv（AUC = 0.929， < 0.0001）、ClCv（AUC = 0.817， = 0.0005）、mOsmCv（AUC = 0.937， < 0.0001）和在 G3 中：NaMean（AUC = 0.976， < 0.001）、mOsmCv（AUC = 0.881， = 0.002）、mOsmMean（AUC = 1.00， < 0.001）是死亡率的最佳预测指标。总体而言，G1+G2+G3 的死亡率预测非常好，AUC = 0.886（ = 0.0002）。接受渗透性药物治疗的危重病患者死亡率较高。电解质失衡是死亡率的独立预测因素，与所使用的治疗方法无关。血浆钠、氯和渗透压的变化是最有害的因素，无论这些参数的绝对值如何。
