Petnak Tananchai, Thongprayoon Charat, Cheungpasitporn Wisit, Shawwa Khaled, Mao Michael A, Kashani Kianoush B
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Nephron. 2022;146(2):153-159. doi: 10.1159/000519686. Epub 2021 Nov 18.
Serum sodium derangement is common in critically ill patients requiring continuous renal replacement therapy (CRRT). We aimed to assess the association between serum sodium before and during CRRT with mortality.
This is a historical cohort study of 1,520 critically ill patients receiving CRRT from December 2006 through November 2015 in a tertiary hospital in the United States. Using logistic regression analysis, we used serum sodium before CRRT, mean serum sodium, and serum sodium changes during CRRT to predict 90-day mortality after CRRT initiation.
Compared with the normal serum sodium levels, the odds ratio (OR) of 90-day mortality in patients with serum sodium before CRRT of 143-147 and ≥148 mmol/L were 1.45 (95% CI 1.03-2.05) and 2.24 (95% CI 1.33-3.87), respectively. There was no significant increase in 90-day mortality in serum sodium of ≤137 mmol/L. During CRRT, the mean serum sodium levels of ≤137 (OR 1.41; 95% CI 1.01-1.98) and ≥143 mmol/L (OR 1.52; 95% CI 1.14-2.03) were associated with higher 90-day mortality. The greater serum sodium changes during CRRT were associated with higher 90-mortality (OR 1.35; 95% CI 1.21-1.51 per 5-mmol/L increase).
Before CRRT initiation, hypernatremia and during CRRT, hypo- and hypernatremia were associated with increased mortality.
血清钠紊乱在需要持续肾脏替代治疗（CRRT）的重症患者中很常见。我们旨在评估CRRT前和CRRT期间的血清钠与死亡率之间的关联。
这是一项历史性队列研究，研究对象为2006年12月至2015年11月在美国一家三级医院接受CRRT的1520例重症患者。我们使用逻辑回归分析，利用CRRT前的血清钠、平均血清钠以及CRRT期间的血清钠变化来预测CRRT开始后90天的死亡率。
与正常血清钠水平相比，CRRT前血清钠为143 - 147 mmol/L和≥148 mmol/L的患者90天死亡率的比值比（OR）分别为1.45（95%可信区间1.03 - 2.05）和2.24（95%可信区间1.33 - 3.87）。血清钠≤137 mmol/L的患者90天死亡率无显著增加。在CRRT期间，平均血清钠水平≤137（OR 1.41；95%可信区间1.01 - 1.98）和≥143 mmol/L（OR 1.52；95%可信区间1.14 - 2.03）与较高的90天死亡率相关。CRRT期间血清钠变化越大，90天死亡率越高（每增加5 mmol/L，OR 1.35；95%可信区间1.21 - 1.51）。
在开始CRRT前，高钠血症以及在CRRT期间，低钠血症和高钠血症均与死亡率增加相关。
