Associations of Hyponatremia with Cognition Function and All-Cause Mortality: Post Hoc Analysis of the Systolic BP Intervention Trial.
Associations of Hyponatremia with Cognition Function and All-Cause Mortality: Post Hoc Analysis of the Systolic BP Intervention Trial.
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DOI：
10.34067/kid.0000000000000224
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发表时间：
2023-10-01
期刊：
影响因子：
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通讯作者：
Beddhu S
中科院分区：
文献类型：
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作者：
Sarwal A;Boucher RE;Abraham N;Singh R;Ye X;Moghaddam FA;Hartsell SE;Wei G;Beddhu S
低钠血症与可能的痴呆有关。偶发性低钠血症似乎与轻度认知障碍或死亡无关。严重低钠血症的急性神经系统影响是众所周知的。然而，低钠血症与认知功能障碍的长期关系尚不清楚。在这项Syphilis血压干预试验的事后分析中，我们研究了低钠血症是否是轻度认知功能障碍（MCI）或可能痴呆（PD）的危险因素。在基线血清钠水平≥130 mmol/L的患者中，我们将前6个月内发生的低钠血症定义为从随机化至6个月访视期间血清钠水平<130 mmol/L的Syphilis血压干预试验安全性警报。在校正了基线认知功能和其他变量的多变量考克斯回归模型中，我们将8540名有认知结果数据的参与者在最初6个月内发生的低钠血症与随后的MCI或PD相关联，并将9135名有死亡数据的参与者与全因死亡率（ACM）相关联。116名参与者（1.4%）在前6个月内发生低钠血症。年龄较大、女性、非黑人、较低的体重指数、随机接受强化收缩压控制与低钠血症的发生有关。与无低钠血症的患者相比，发生低钠血症的患者发生PD的风险更高（2.1 vs 0.9起事件/100人-年;风险比[HR]，3.08; 95%置信区间[CI]，1.48 - 6.41），但不是MCI（3.1 vs 3.6起事件/100人-年; HR，0.95; 95% CI，0.54 - 1.68）和MCI/PD复合终点（5.0 vs 4.2起事件/100人-年; HR，1.28; 95% CI，0.82 - 2.0）。ACM无显著差异（HR，1.84; 95% CI，0.90 - 3.73）。低钠血症事件与PD而非MCI或死亡相关的生物学合理性尚不清楚。事件性低钠血症与PD的关联可能反映了偶然发现或非因果生物学关联或因果关系。
Incident hyponatremia is associated with probable dementia. Incident hyponatremia does not seem to be associated with mild cognitive impairment or death. Acute neurologic effects of severe hyponatremia are well-known. However, the long-term association of hyponatremia with cognitive impairment is unclear. In this post hoc analysis of the Systolic Blood Pressure Intervention Trial, we examined whether incident hyponatremia is a risk factor of mild cognitive impairment (MCI) or probable dementia (PD). In those with baseline serum sodium level ≥130 mmol/L, we defined incident hyponatremia in the first 6 months as a Systolic Blood Pressure Intervention Trial safety alert for serum sodium level <130 mmol/L from randomization to the 6-month visit. In multivariate Cox regression models adjusted for baseline cognitive function and other variables, we related incident hyponatremia in the first 6 months with subsequent MCI or PD in 8540 participants with cognitive outcomes data and with all-cause mortality (ACM) in 9135 participants with mortality data. Incident hyponatremia in the first 6 months was noted in 116 participants (1.4%). Older age, female sex, non-Black race, lower body mass index, and randomization to intensive systolic BP control were associated with incident hyponatremia. Compared with those without hyponatremia, those with incident hyponatremia had higher risk of PD (2.1 versus 0.9 events/100 person-years; hazard ratio [HR], 3.08; 95% confidence interval [CI], 1.48 to 6.41) but not MCI (3.1 versus 3.6 events/100 person-years; HR, 0.95; 95% CI, 0.54 to 1.68) and the composite of MCI/PD (5.0 versus 4.2 events/100 person-years; HR, 1.28; 95% CI, 0.82 to 2.0). There were no significant differences in ACM (HR, 1.84; 95% CI, 0.90 to 3.73). Biologic plausibility for the association of incident hyponatremia with PD but not MCI or death is unclear. The association of incident hyponatremia with PD could reflect a chance finding or noncausal biologic association or causal relationship.