Liang Siyu, Sun Lize, Zhang Yuelun, Zhang Qi, Jiang Nan, Zhu Huijuan, Chen Shi, Pan Hui
Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Eight-year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Front Med (Lausanne). 2024 Jul 16;11:1399638. doi: 10.3389/fmed.2024.1399638. eCollection 2024.
Dysnatremia is the most common electrolyte disorder in hospitalized patients. Sodium fluctuation level may be a better parameter in dysnatremia management. We aimed to examine the association between sodium fluctuation level during hospitalization and mortality and to evaluate its value in predicting poor prognosis among general hospitalized patients.
Data were collected from patients admitted to Peking Union Medical College Hospital. The generalized estimated equation (GEE) was used to examine the relationship between sodium fluctuation level and mortality. Receiver-operating characteristic (ROC) curve analysis was performed to calculate the optimal cutoff value and the area under the ROC curve (AUC).
Sodium fluctuation level showed a dose-dependent association with increased mortality in general hospitalized patients. After adjusting age, sex, length of hospital stay, and Charlson comorbidity index, the ORs of group G2 to G6 were 5.92 (95% CI 5.16-6.79), 26.45 (95% CI 22.68-30.86), 50.71 (95% CI 41.78-61.55), 104.38 (95% CI 81.57-133.58), and 157.64 (95% CI 112.83-220.24), respectively, trend <0.001. Both normonatremia and dysnatremia patients on admission had the dose-dependent associations similar to general hospitalized patients. The AUC of sodium fluctuation level was 0.868 (95% CI 0.859-0.877) in general hospitalized patients, with an optimal cutoff point of 7.5 mmol/L, a sensitivity of 76.5% and a specificity of 84.2%.
We determined that sodium fluctuation level had a dose-dependent association with increased mortality in general hospitalized patients. Sodium fluctuation level could be used to develop a single parameter system in predicting mortality in general hospitalized patients with acceptable accuracy, sensitivity, and specificity.
低钠血症是住院患者中最常见的电解质紊乱。钠波动水平可能是低钠血症管理中一个更好的参数。我们旨在研究住院期间钠波动水平与死亡率之间的关联，并评估其在预测普通住院患者不良预后方面的价值。
收集北京协和医院收治患者的数据。采用广义估计方程（GEE）来研究钠波动水平与死亡率之间的关系。进行受试者工作特征（ROC）曲线分析以计算最佳截断值和ROC曲线下面积（AUC）。
在普通住院患者中，钠波动水平与死亡率增加呈剂量依赖性关联。在调整年龄、性别、住院时间和Charlson合并症指数后，G2至G6组的比值比分别为5.92（95%可信区间5.16 - 6.79）、26.45（95%可信区间22.68 - 30.86）、50.71（95%可信区间41.78 - 61.55）、104.38（95%可信区间81.57 - 133.58）和157.64（95%可信区间112.83 - 220.24），趋势<0.001。入院时的血钠正常和低钠血症患者均具有与普通住院患者相似的剂量依赖性关联。普通住院患者中钠波动水平的AUC为0.868（95%可信区间0.859 - 0.877），最佳截断点为7.5 mmol/L，敏感性为76.5%，特异性为84.2%。
我们确定钠波动水平与普通住院患者死亡率增加呈剂量依赖性关联。钠波动水平可用于建立一个单一参数系统，以可接受的准确性、敏感性和特异性预测普通住院患者的死亡率。
