Academic Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin, Ireland.
Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland.
Eur J Endocrinol. 2021 Jan;184(1):9-17. doi: 10.1530/EJE-20-0577.
Severe hyponatraemia (plasma sodium concentration, pNa <120 mmol/L) is reported to be associated with mortality rates as high as 50%. Although there are several international guidelines for the management of severe hyponatraemia, there are few data on the impact of treatment.
We have longitudinally reviewed rates of specialist input, active management of hyponatraemia, treatment outcomes and mortality rates in patients with severe hyponatraemia (pNa <120 mmol/L) in 2005, 2010 and 2015, and compared the recent mortality rate with that of patients with pNa 120-125 mmol/L.
Between 2005 and 2010 there was a doubling in the rate of specialist referral (32 to 68%, P = 0.003) and an increase in the use of active management of hyponatraemia in patients with pNa <120 mmol/L (63 to 88%, P = 0.02), associated with a reduction in mortality from 51 to 15% (P < 0.001). The improved rates of intervention were maintained between 2010 and 2015, but there was no further reduction in mortality. When data from all three reviews were pooled, specialist consultation in patients with pNa <120 mmol/L was associated with a 91% reduction in mortality risk, RR 0.09 (95% CI: 0.03-0.26), P < 0.001. Log-rank testing on in-hospital survival in 2015 found no significant difference between patients with pNa <120 mmol/L and pNa 120-125 mmol/L (P = 0.56).
Dedicated specialist input and active management of severe hyponatraemia are associated with a reduction in mortality, to rates comparable with moderate hyponatraemia.
据报道，严重低钠血症（血浆钠浓度，pNa <120mmol/L）的死亡率高达 50%。尽管有几个国际指南用于治疗严重低钠血症，但关于治疗效果的数据却很少。
我们对 2005 年、2010 年和 2015 年严重低钠血症（pNa <120mmol/L）患者的专家介入率、低钠血症的积极治疗、治疗结果和死亡率进行了纵向回顾，并将近期死亡率与 pNa 120-125mmol/L 患者的死亡率进行了比较。
在 2005 年至 2010 年期间，专家转诊率翻了一番（32%至 68%，P = 0.003），pNa <120mmol/L 患者中低钠血症积极治疗的使用率也有所增加（63%至 88%，P = 0.02），死亡率从 51%降至 15%（P < 0.001）。在 2010 年至 2015 年期间，干预率的提高得以维持，但死亡率没有进一步降低。当汇总所有三次审查的数据时，pNa <120mmol/L 患者的专家咨询与死亡率降低 91%相关，RR 0.09（95%CI：0.03-0.26），P < 0.001。2015 年住院期间生存的对数秩检验发现，pNa <120mmol/L 与 pNa 120-125mmol/L 之间的死亡率无显著差异（P = 0.56）。
专门的专家介入和严重低钠血症的积极治疗与死亡率降低相关，降低至与中度低钠血症相当的水平。
