Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34149 Italy.
Internal Medicine Department, University Hospital, Trieste, 34149 Italy.
Age Ageing. 2021 Jun 28;50(4):1151-1158. doi: 10.1093/ageing/afaa264.
impaired hydration is common in the older people, however studies of its effects on outcome in the acute setting are limited.
to assess (i) the prevalence of impaired hydration, (ii) its relationship with laboratory markers of altered hydration and with (iii) short- and long-term mortality.
retrospective cohort study.
University Hospital-Internal Medicine Department.
a total of 5,113 older patients consecutively acutely admitted from October 2015 to July 2016.
according to calculated serum osmolarity at admission hydration status was stratified in: low osmolarity (<275 mmol/L), euhydration (275-295 mmol/L), impending (296-300 mmol/L) and current dehydration (>300 mmol/L). Relationships with serum sodium, potassium, glucose, urea, estimated glomerular filtration rate (eGFR), haematocrit, urea/creatinine ratio (Urea/Cr) and urine specific gravity (USG) were determined. Charlson Comorbidity Index, Modified Early Warning Score, Glasgow Prognostic Score, Norton score and Nutritional Risk Screening-2002 were calculated.
current and impending dehydration, euhydration and low-osmolarity were detected in 51.7, 17.1, 28.5 and 2.7% of the patients, respectively. Osmolarity correlated with urea (r = 0.846). Associations with serum sodium, creatinine, eGFR and urea/Cr were low but significant, being negligible that with USG and haematocrit. Serum sodium and urea increased in the transition from low- to high-osmolarity (P < 0.001 in all pairwise comparisons). In multivariate modelling current dehydration, functional dependence, clinical instability and high nutritional risk were associated (P < 0.001) with reduced short- and long-term survival.
impaired hydration is common in older people acutely admitted to medical care and is associated with poor outcome. Early assessment of calculated serum osmolarity is mandatory to target dehydration and hypoosmolar disorders.
老年人普遍存在脱水问题，但有关急性脱水对预后影响的研究有限。
评估（i）脱水的发生率，（ii）其与实验室水合改变标志物的关系，以及（iii）短期和长期死亡率的关系。
回顾性队列研究。
大学医院-内科。
2015 年 10 月至 2016 年 7 月连续收治的 5113 例老年急性患者。
根据入院时计算的血清渗透压，将水合状态分层为：低渗透压（<275mmol/L）、正常渗透压（275-295mmol/L）、即将发生（296-300mmol/L）和当前脱水（>300mmol/L）。测定血清钠、钾、葡萄糖、尿素、估算肾小球滤过率（eGFR）、红细胞压积、尿素/肌酐比值（Urea/Cr）和尿比重（USG）与水合状态的关系。计算 Charlson 合并症指数、改良早期预警评分、格拉斯哥预后评分、诺顿评分和营养风险筛查 2002（NRS 2002）。
当前和即将发生的脱水、正常渗透压和低渗透压分别在 51.7%、17.1%、28.5%和 2.7%的患者中发现。渗透压与尿素呈正相关（r=0.846）。与血清钠、肌酐、eGFR 和 Urea/Cr 的相关性虽然低但有统计学意义，而与 USG 和红细胞压积的相关性可以忽略不计。低渗透压向高渗透压转变时，血清钠和尿素均增加（所有两两比较均 P<0.001）。多变量模型显示，当前脱水、功能依赖、临床不稳定和高营养风险与短期和长期生存降低相关（P<0.001）。
老年人急性入院时普遍存在脱水，且与不良预后相关。早期评估计算的血清渗透压对于治疗脱水和低渗透压紊乱至关重要。
