Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
Clin Exp Nephrol. 2021 Feb;25(2):131-139. doi: 10.1007/s10157-020-01967-9. Epub 2020 Sep 22.
Hypernatremia is a major electrolyte disorder associated with death among critically ill patients. Glucocorticoid therapy may cause hypernatremia in refractory septic shock patients, but the association between glucocorticoid and intensive care unit (ICU)-acquired hypernatremia (IAH) remains unclear. The aim of this study was to clarify whether glucocorticoid administration was associated with IAH.
This was a nested case-control study using data from an established cohort including 121 IAH cases identified from 1756 patients who were admitted to ICU in a tertiary care facility in Japan. We included patients who were admitted with a normal range of serum sodium concentrations (130-149 mEq/L) from January 1, 2013 to December 31, 2015 and remained in ICU for ≥ 2 days. Hypernatremia was defined as serum sodium concentration ≥ 150 mEq/L. Each case was matched to one control.
Multivariable conditional logistic regression revealed high-dose glucocorticoid {odds ratio (OR), 4.15 [95% confidence interval (CI) 1.29-13.4]}, acute kidney injury (AKI) [OR, 2.72 (95% CI 1.31-5.62)], and osmotic diuretics [OR, 3.44 (95% CI 1.41-8.39)] to be significantly associated with IAH. The contents and amounts of fluid infusion were not significantly associated with IAH. There were also significant duration-response effects between duration of glucocorticoid use and IAH; however, pulse glucocorticoid administration was not associated with IAH.
In this nested case-control study, we demonstrated a significant association between IAH and high-dose glucocorticoid with significant duration-response effects. Serum sodium concentrations should be monitored carefully in critically ill patients administered prolonged high-dose glucocorticoid.
高钠血症是与危重病患者死亡相关的主要电解质紊乱。糖皮质激素治疗可能导致难治性脓毒性休克患者发生高钠血症，但糖皮质激素与重症监护病房（ICU）获得性高钠血症（IAH）之间的关系尚不清楚。本研究旨在阐明糖皮质激素的应用是否与 IAH 相关。
这是一项使用来自日本一家三级医疗机构的已建立队列数据的嵌套病例对照研究，共纳入了 1756 例 ICU 患者中的 121 例 IAH 病例。我们纳入了血清钠浓度正常范围（130-149 mEq/L）且在 ICU 中住院时间≥2 天的患者。高钠血症定义为血清钠浓度≥150 mEq/L。每个病例均与 1 个对照相匹配。
多变量条件逻辑回归显示，大剂量糖皮质激素（优势比 [OR]，4.15 [95%置信区间 [CI] 1.29-13.4]）、急性肾损伤（AKI）[OR，2.72（95% CI 1.31-5.62）]和渗透性利尿剂（OR，3.44 [95% CI 1.41-8.39））与 IAH 显著相关。液体输注的内容和量与 IAH 无显著相关性。糖皮质激素使用时间与 IAH 之间也存在显著的时间反应关系，但脉冲糖皮质激素治疗与 IAH 无关。
在这项嵌套病例对照研究中，我们证实了 IAH 与大剂量糖皮质激素之间存在显著关联，且存在显著的时间反应关系。接受长期大剂量糖皮质激素治疗的危重病患者应密切监测血清钠浓度。
