Moderate Hyponatremia Is Associated with Increased Risk of Mortality: Evidence from a Meta-Analysis
Moderate Hyponatremia Is Associated with Increased Risk of Mortality: Evidence from a Meta-Analysis
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DOI：
10.1371/journal.pone.0080451
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发表时间：
2013-12-18
期刊：
影响因子：
3.7
通讯作者：
Peri, Alessandro
中科院分区：
文献类型：
--
作者：
Corona, Giovanni;Giuliani, Corinna;Peri, Alessandro
背景：低钠血症是临床实践中最常见的电解质紊乱，迄今为止的证据表明严重的低钠血症与发病率和死亡率增加相关。我们研究的目的是进行一项荟萃分析，其中包括已发表的研究，比较患有或不患有任何程度的低钠血症的受试者的死亡率。方法和结果：进行了广泛的 Medline、Embase 和 Cochrane 检索，以检索截至 2012 年 10 月 1 日发表的研究，使用以下词语：“低钠血症”和“死亡率”。 81 项研究满足纳入标准，共涉及 850222 名患者，其中 17.4% 患有低钠血症。相关摘要的识别、研究的选择和随后的数据提取由两位作者独立完成，冲突由第三位研究者解决。在所有 81 项研究中，低钠血症与总体死亡率风险增加显着相关 (RR = 2.60[2.31-2.93])。低钠血症还与心肌梗塞 (RR = 2.83[2.23-3.58])、心力衰竭 (RR = 2.47[2.09-2.92])、肝硬化 (RR = 3.34[1.91-5.83])、肺部感染 (RR = 2.49[1.44-4.30])、混合疾病 (RR = 2.59[1.97-3.40]），以及住院患者（RR = 2.48[2.09-2.95]）。死亡受试者与幸存者相比，血清 [Na+] 平均差异为 4.8 mmol/L（130.165.6 vs 134.965.1 mmol/L）。荟萃回归分析显示，低钠血症相关的总体死亡率风险与血清[Na+]呈负相关。在调整了年龄、性别和糖尿病作为相关发病率后，这种关联在多元回归模型中得到了证实。结论：这项荟萃分析首次表明，在大量患者的常见临床症状中，即使是中度血清 [Na+] 降低也与死亡风险增加相关。
Background: Hyponatremia is the most common electrolyte disorder in clinical practice, and evidence to date indicates that severe hyponatremia is associated with increased morbidity and mortality. The aim of our study was to perform a meta-analysis that included the published studies that compared mortality rates in subjects with or without hyponatremia of any degree.Methods and Findings: An extensive Medline, Embase and Cochrane search was performed to retrieve the studies published up to October 1st 2012, using the following words: "hyponatremia" and "mortality". Eighty-one studies satisfied inclusion criteria encompassing a total of 850222 patients, of whom 17.4% were hyponatremic. The identification of relevant abstracts, the selection of studies and the subsequent data extraction were performed independently by two of the authors, and conflicts resolved by a third investigator. Across all 81 studies, hyponatremia was significantly associated with an increased risk of overall mortality (RR = 2.60[2.31-2.93]). Hyponatremia was also associated with an increased risk of mortality in patients with myocardial infarction (RR = 2.83[2.23-3.58]), heart failure (RR = 2.47[2.09-2.92]), cirrhosis (RR = 3.34[1.91-5.83]), pulmonary infections (RR = 2.49[1.44-4.30]), mixed diseases (RR = 2.59[1.97-3.40]), and in hospitalized patients (RR = 2.48[2.09-2.95]). A mean difference of serum [Na+] of 4.8 mmol/L was found in subjects who died compared to survivors (130.165.6 vs 134.965.1 mmol/L). A meta-regression analysis showed that the hyponatremia-related risk of overall mortality was inversely correlated with serum [Na+]. This association was confirmed in a multiple regression model after adjusting for age, gender, and diabetes mellitus as an associated morbidity.Conclusions: This meta-analysis shows for the first time that even a moderate serum [Na+] decrease is associated with an increased risk of mortality in commonly observed clinical conditions across large numbers of patients.