Hsu Shiun-Yuan, Rau Cheng-Shyuan, Tsai Ching-Hua, Chou Sheng-En, Su Wei-Ti, Hsieh Ching-Hua
Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Diagnostics (Basel). 2024 Feb 6;14(4):355. doi: 10.3390/diagnostics14040355.
Hyponatremia and hypokalemia are common electrolyte imbalances in trauma patients and have been identified to be risk factors for a fall. In addition, hyponatremia was reported to be related to osteoporosis and fragility fractures, while the association between hypokalemia and osteoporosis has only been reported in rare case reports. This study investigated the impact of hyponatremia and hypokalemia on the incidence of fractures in various body regions of adult trauma patients, using the propensity score-matched patient cohort to reduce the influence of patients' baseline characteristics.
The study analyzed data from 11,173 hospitalized adult trauma patients treated from 1 January 1998, to 31 December 2022. The study included 1968 patients with hyponatremia and 9205 without, and 1986 with hypokalemia and 9187 without. Different 1:1 propensity score-matched cohorts were generated to create the 1903 pairings of patients with or without hyponatremia, 1977 pairings of patients with or without hypokalemia, and 380 pairing of patients with both hyponatremia and hypokalemia vs. normal control patients. Analysis was conducted on the incidence of fracture in various anatomic regions.
Hyponatremic patients had increased odds of thoracic vertebral fracture [odds ratio (95% confidence interval) 1.63 (1.10-2.42), = 0.014], pelvic fracture [2.29 (1.12-4.67), = 0.019], and femoral fracture [1.28 (1.13-1.45), < 0.001] but decreased odds of radial and patella fractures. Hypokalemic patients showed no significant differences in fracture risk except for a decreased likelihood of radial fractures. The patients with both hyponatremia and hypokalemia showed a decreased likelihood of radial fractures and patella fractures.
Hyponatremia may have a greater impact on the occurrence of bone fractures than hypokalemia in trauma patients who have suffered a fall. Electrolyte abnormalities should be taken into account while assessing the risk of fractures in trauma patients.
低钠血症和低钾血症是创伤患者常见的电解质失衡，已被确定为跌倒的危险因素。此外，据报道低钠血症与骨质疏松症和脆性骨折有关，而低钾血症与骨质疏松症之间的关联仅在少数病例报告中有所提及。本研究使用倾向评分匹配的患者队列来减少患者基线特征的影响，调查低钠血症和低钾血症对成年创伤患者身体各部位骨折发生率的影响。
该研究分析了1998年1月1日至2022年12月31日期间11173例住院成年创伤患者的数据。该研究包括1968例低钠血症患者和9205例无低钠血症患者，以及1986例低钾血症患者和9187例无低钾血症患者。生成了不同的1:1倾向评分匹配队列，以创建1903对有或无低钠血症的患者配对、1977对有或无低钾血症的患者配对，以及380对同时患有低钠血症和低钾血症的患者与正常对照患者配对。对各个解剖区域的骨折发生率进行了分析。
低钠血症患者胸椎骨折的几率增加[比值比（95%置信区间）1.63（1.10 - 2.42），P = 0.014]、骨盆骨折[2.29（1.12 - 4.67），P = 0.019]和股骨骨折[1.28（1.13 - 1.45），P < 0.001]，但桡骨和髌骨骨折的几率降低。低钾血症患者除桡骨骨折可能性降低外，骨折风险无显著差异。同时患有低钠血症和低钾血症的患者桡骨骨折和髌骨骨折的可能性降低。
在跌倒的创伤患者中，低钠血症对骨折发生的影响可能比低钾血症更大。在评估创伤患者骨折风险时应考虑电解质异常情况。
