See Xin Ya, Chang Yu-Cheng, Peng Chun-Yu, Wang Shih-Syuan, Chi Kuan-Yu, Chiang Cho-Hung, Chiang Cho-Han
Unity Hospital, Rochester Regional Health, Rochester, NY, USA.
Danbury Hospital, Danbury, CT, USA.
J Crit Care Med (Targu Mures). 2024 Jul 31;10(3):209-212. doi: 10.2478/jccm-2024-0030. eCollection 2024 Jul.
Current guidelines recommend limiting the rate of correction in patients with severe hyponatremia to avoid severe neurologic complications such as osmotic demyelination syndrome (ODS). However, published data have been conflicting. We aimed to evaluate the association between rapid sodium correction and ODS in patients with severe hyponatremia.
We searched PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to November 2023. The primary outcome was ODS and the secondary outcomes were in-hospital mortality and length of hospital stay.
We identified 7 cohort studies involving 6,032 adult patients with severe hyponatremia. Twenty-nine patients developed ODS, resulting in an incidence rate of 0.48%. Seventeen patients (61%) had a rapid correction of serum sodium in the first or any 24-hour period of admission. Compared with a limited rate of sodium correction, a rapid rate of sodium correction was associated with an increased risk of ODS (RR, 3.91 [95% CI, 1.17 to 13.04]; I = 44.47%; p = 0.03). However, a rapid rate of sodium correction reduced the risk of in-hospital mortality by approximately 50% (RR, 0.51 [95% CI, 0.39 to 0.66]; I = 0.11%; p < 0.001) and the length of stay by 1.3 days (Mean difference, -1.32 [95% CI, -2.54 to -0.10]; I = 71.47%; p = 0.03).
Rapid correction of serum sodium may increase the risk of ODS among patients hospitalized with severe hyponatremia. However, ODS may occur in patients regardless of the rate of serum sodium correction.
当前指南建议限制严重低钠血症患者的血钠纠正速度，以避免严重的神经系统并发症，如渗透性脱髓鞘综合征（ODS）。然而，已发表的数据相互矛盾。我们旨在评估严重低钠血症患者快速纠正血钠与ODS之间的关联。
我们检索了自数据库建立至2023年11月的PubMed、Embase、Scopus、Web of Science和Cochrane对照试验中心注册库。主要结局是ODS，次要结局是住院死亡率和住院时间。
我们纳入了7项队列研究，涉及6032例成年严重低钠血症患者。29例患者发生了ODS，发病率为0.48%。17例患者（61%）在入院后的第一个或任何24小时内血钠快速纠正。与有限的血钠纠正速度相比，快速血钠纠正与ODS风险增加相关（风险比，3.91[95%置信区间，1.17至13.04]；I² = 44.47%；p = 0.03）。然而，快速血钠纠正使住院死亡率风险降低了约50%（风险比，0.51[95%置信区间，0.39至0.66]；I² = 0.11%；p < 0.001），住院时间缩短了1.3天（平均差值，-1.32[95%置信区间，-2.54至-0.10]；I² = 71.47%；p = 0.03）。
严重低钠血症住院患者快速纠正血钠可能会增加ODS风险。然而，无论血钠纠正速度如何，患者都可能发生ODS。
