Academic Department of Endocrinology, RCSI Medical School and Beaumont Hospital, Dublin, Ireland.
Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland.
Age Ageing. 2021 Jun 28;50(4):1144-1150. doi: 10.1093/ageing/afaa248.
Hyponatraemia is associated with increased morbidity and mortality; the aetiology and outcomes of hyponatraemia in older patients have not been defined in prospective studies.
A single-centre 9-month prospective observational study in which clinical outcomes in hospitalised patients ≥ 65 years (older patients with hyponatraemia (OP-HN)) and those <65 years (young patients with hyponatraemia (YP-HN)) with hyponatraemia were analysed, and compared with eunatraemic controls (older patients with normonatraemia (OP-NN) and young patients with normonatraemia (YP-NN)).
In total, 1,321 episodes of hyponatraemia in 1,086 patients were included; 437 YP-HN, median age 54 years (IQR 44,60) and 884 OP-HN, median age 77 years (IQR 71,82). A total of 1,120 consecutive eunatraemic control patients were simultaneously recruited; 690 OP-NN, median age 77 years (IQR 71,83) and 430 YP-NN, median age 52 years (IQR 41,58). Euvolaemic hyponatraemia was the commonest cause of hyponatraemia in both age groups (48% in YP-HN and 46% in OP-HN). Sixty-two percent of OP-HN received hyponatraemia-directed treatment within the initial 48 h, compared with 55% of YP-HN, P = 0.01. Despite the greater treatment rates in OP-HN, younger patients were 24% more likely to be discharged with normal plasma sodium concentration (pNa) compared with older patients, relative risk (RR) 1.24 (95% confidence interval (CI) 1.12-1.37), P < 0.001.Using OP-NN as the reference group, the RR of in-hospital death in OP-HN was 2.15 (95% CI 1.3-3.56), P = 0.002. Using YP-NN as the reference group, the RR of in-hospital death in YP-HN was 4.34 (95% CI 1.98-9.56), P < 0.001.
Despite greater rates of HN-targeted treatment, the risk of in-hospital death is increased in older hyponatraemic patients compared with older eunatraemic controls. The impact of hyponatraemia on mortality is even greater in younger patients.
低钠血症与发病率和死亡率的增加有关；在前瞻性研究中，尚未明确老年人低钠血症的病因和结局。
这是一项为期 9 个月的单中心前瞻性观察研究，分析了住院患者中≥65 岁（伴有低钠血症的老年患者（OP-HN））和<65 岁（伴有低钠血症的年轻患者（YP-HN））的临床结局，并与正常血钠的对照组进行了比较（伴有正常血钠的老年患者（OP-NN）和伴有正常血钠的年轻患者（YP-NN））。
共纳入了 1086 例患者的 1321 例低钠血症发作，其中 437 例 YP-HN，中位年龄 54 岁（IQR 44，60），884 例 OP-HN，中位年龄 77 岁（IQR 71，82）。同时招募了 1120 例连续的 eunatraemic 对照患者，其中 690 例 OP-NN，中位年龄 77 岁（IQR 71，83），430 例 YP-NN，中位年龄 52 岁（IQR 41，58）。等容性低钠血症是两个年龄组中低钠血症的最常见原因（YP-HN 中占 48%，OP-HN 中占 46%）。与 YP-HN 相比，OP-HN 中有 62%的患者在最初的 48 小时内接受了低钠血症靶向治疗，而 YP-HN 中有 55%的患者接受了治疗，P=0.01。尽管 OP-HN 的治疗率较高，但与老年患者相比，年轻患者出院时血浆钠浓度正常的可能性高 24%，相对风险（RR）为 1.24（95%置信区间（CI）为 1.12-1.37），P<0.001。以 OP-NN 为参考组，OP-HN 住院死亡的 RR 为 2.15（95%CI 1.3-3.56），P=0.002。以 YP-NN 为参考组，YP-HN 住院死亡的 RR 为 4.34（95%CI 1.98-9.56），P<0.001。
尽管针对 HN 的治疗率较高，但与老年 eunatraemic 对照组相比，老年低钠血症患者的住院死亡风险增加。低钠血症对死亡率的影响在年轻患者中更为显著。
