Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, Santa Maria della Misericordia Hospital, University of Perugia, Piazzale Gambuli 1, 06132, Perugia, Italy.
Division of Clinical Geriatrics, NVS Department, Karolinska Institutet, Stockholm, Sweden.
Aging Clin Exp Res. 2022 Oct;34(10):2547-2552. doi: 10.1007/s40520-022-02185-x. Epub 2022 Jul 6.
Assessment of hydration status is complex and difficult to detect in older persons. Different methods have been developed to determine hydration status in clinical settings, but their diagnostic accuracy remains questionable.
The aim of this study was to determine and compare the diagnostic accuracy of all methods routinely used in acute settings to detect dehydration in a cohort of hospitalized oldest-old persons, using as primary reference standard blood urea nitrogen (BUN) to creatinine ratio.
This retrospective study was conducted on 59 oldest-old subjects at hospital admission in an acute setting, with complete physical, biochemical, bioelectrical impedance analysis (BIA) and ultrasound assessment, including inferior vena cava diameters.
Fifty-nine (45 women/14 men) subjects, with a mean age of 87.4 ± 5.9 years, were studied. Based on the value of the BUN/creatinine ratio, the whole population was divided into hyperhydrated (n = 10), normohydrated (n = 42), and dehydrated (n = 7) groups. Among parameters indicating the hydration status, serum sodium levels (p < 0.0001), serum chloride levels (p = 0.010), calculated plasma osmolarity (p < 0.0001), and fat mass (FM) (p = 0.030) differed significantly among groups. A ROC analysis showed that the highest and most significant value for dehydration detection was the calculated plasma osmolarity (AUC: 0.820, p = 0.013), which significantly correlated with clinical parameters including heart rate (r = 0.300; p = 0.021), capillary refill (r = 0.379; p = 0.013) and systolic blood pressure (r = - 0.261; p = 0.046).
The measurement of calculated serum osmolarity is simple and inexpensive and may quickly provide high sensitivity and specificity indication of dehydration in hospitalized oldest-old persons.
评估老年人的水合状态较为复杂，且难以检测。目前已开发出多种方法来确定临床环境中的水合状态，但这些方法的诊断准确性仍存在疑问。
本研究旨在确定并比较常规用于急性环境中以检测住院高龄患者脱水的所有方法的诊断准确性，将血尿素氮（BUN）与肌酐比值作为主要参考标准。
本回顾性研究纳入了 59 名在急性环境下入院的高龄患者，对其进行了完整的体格检查、生化检查、生物电阻抗分析（BIA）和超声评估，包括下腔静脉直径。
研究共纳入 59 名（45 名女性/14 名男性）患者，平均年龄为 87.4±5.9 岁。根据 BUN/肌酐比值，将整个人群分为高血容量组（n=10）、正常血容量组（n=42）和脱水组（n=7）。在提示水合状态的参数中，血清钠水平（p<0.0001）、血清氯水平（p=0.010）、计算得出的血浆渗透压（p<0.0001）和脂肪量（FM）（p=0.030）在各组间差异有统计学意义。ROC 分析显示，检测脱水的最佳且最显著的参数为计算得出的血浆渗透压（AUC：0.820，p=0.013），其与心率（r=0.300；p=0.021）、毛细血管再充盈时间（r=0.379；p=0.013）和收缩压（r=-0.261；p=0.046）等临床参数显著相关。
计算得出的血清渗透压测量简单且经济实惠，可快速提供关于住院高龄患者脱水的高灵敏度和高特异性指标。
