Marahrens Benedikt, Damsch Leah, Lehmann Rebecca, Matyukhin Igor, Patschan Susann, Patschan Daniel
Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Universitatsklinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Germany.
These authors contributed equally to the study.
J Clin Med Res. 2023 Feb;15(2):90-98. doi: 10.14740/jocmr4845. Epub 2023 Feb 28.
Over the last decades, acute kidney injury (AKI) has been identified as a potentially fatal diagnosis which substantially increases in-hospital mortality in the short term and morbidity/mortality in the long term. However, reliable biomarkers for predicting AKI-associated outcomes are still missing. In this study, we assessed whether serum sodium, measured at different time points during the in-hospital treatment period, provided prognostic information in AKI.
This was a retrospective, observational cohort study. AKI subjects were identified via the in-hospital AKI alert system. Serum sodium and potassium levels were documented at five pre-defined time points: hospital admission, AKI onset, minimum estimated glomerular filtration rate, minimum and maximum of the respective electrolyte during the treatment period. In-hospital death, the need for kidney replacement therapy (KRT) and recovery of kidney function were defined as endpoints.
Patients who suffered in-hospital death (n = 37, 23.1%) showed significantly higher serum sodium levels at diagnosis of AKI (survivors: 145.7 ± 2.13 vs. non-survivors: 138.8 ± 0.636 mmol/L, P = 0.003). A logistic regression model was significant for serum sodium levels in patients with in-hospital death (X, P = 0.003; odds ratio = 1.08 (1.022 - 1.141); R = 0.082; d = 0.089). This suggests an increase of the relative risk for in-hospital death by 8% with every unit of serum sodium increase. Patients with a sodium above the upper normal range at AKI diagnosis were also more likely to suffer in-hospital death (P = 0.001).
In summary, we present evidence that serum sodium, measured at time of AKI diagnosis, potentially serves as a predictor for in-hospital death in patients with AKI.
在过去几十年中，急性肾损伤（AKI）已被确认为一种潜在的致命诊断，它会在短期内大幅增加住院死亡率，并在长期内增加发病率/死亡率。然而，用于预测AKI相关结局的可靠生物标志物仍然缺失。在本研究中，我们评估了在住院治疗期间不同时间点测量的血清钠是否能为AKI提供预后信息。
这是一项回顾性观察队列研究。通过住院AKI警报系统识别AKI患者。在五个预先定义的时间点记录血清钠和钾水平：入院时、AKI发病时、最低估计肾小球滤过率、治疗期间各电解质的最低值和最高值。将住院死亡、肾脏替代治疗（KRT）需求和肾功能恢复定义为终点。
住院死亡的患者（n = 37，23.1%）在AKI诊断时血清钠水平显著更高（幸存者：145.7 ± 2.13 vs. 非幸存者：138.8 ± 0.636 mmol/L，P = 0.003）。逻辑回归模型对住院死亡患者的血清钠水平具有显著意义（X，P = 0.003；比值比 = 1.08（1.022 - 1.141）；R = 0.082；d = 0.089）。这表明血清钠每增加一个单位，住院死亡的相对风险增加8%。在AKI诊断时钠高于正常范围上限的患者也更有可能住院死亡（P = 0.001）。
总之，我们提供的证据表明，在AKI诊断时测量的血清钠可能作为AKI患者住院死亡的预测指标。
