ICU-Acquired Hypernatremia Is Associated with Persistent Inflammation, Immunosuppression and Catabolism Syndrome.
ICU-Acquired Hypernatremia Is Associated with Persistent Inflammation, Immunosuppression and Catabolism Syndrome.
复制标题
DOI：
10.3390/jcm9093017
复制
发表时间：
2020-09-18
影响因子：
3.9
通讯作者：
Kreutziger J
中科院分区：
文献类型：
--
作者：
Rugg C;Ströhle M;Treml B;Bachler M;Schmid S;Kreutziger J
在重症监护病房（ICU）发生高钠血症是一个常见的问题，有各种不良反应。与持续炎症、免疫抑制和分解代谢综合征（PICS）的联系可以通过两种方式建立。一方面，高钠血症可通过高渗细胞应激导致炎症和分解代谢，另一方面，深度分解代谢可通过尿素诱导的渗透性利尿导致高钠血症。在这项回顾性单中心研究中，我们检查了115例ICU住院时间延长（≥14天）且肾功能良好的患者。根据患者在ICU第7天至第21天的血清钠浓度，将患者分为高钠血症组（高）和非高钠血症组（低）。在整个队列中可检测到明显的PICS征象。其中33例（28.7%）患有ICU获得性高钠血症，这与明显较高的炎症症状和持续的分解代谢以及延长的ICU住院时间有关。尿素生成率和尿素与肌酐比值比血清白蛋白浓度更能识别分解代谢。高钠血症的一个可分配的原因是尿素诱导的渗透性利尿。在处理需要长期治疗的ICU患者时，高钠血症至少应该引发PICS作为一个促成因素的想法。在这方面，尿素与肌酐比值是一种容易获得的分解代谢的生物标志物。
Developing hypernatremia while on intensive care unit (ICU) is a common problem with various undesirable effects. A link to persistent inflammation, immunosuppression and catabolism syndrome (PICS) can be established in two ways. On the one hand, hypernatremia can lead to inflammation and catabolism via hyperosmolar cell stress, and on the other, profound catabolism can lead to hypernatremia via urea-induced osmotic diuresis. In this retrospective single-center study, we examined 115 patients with prolonged ICU stays (≥14 days) and sufficient renal function. Depending on their serum sodium concentrations between ICU day 7 and 21, allocation to a hypernatremic (high) and a nonhypernatremic group (low) took place. Distinct signs of PICS were detectable within the complete cohort. Thirty-three of them (28.7%) suffered from ICU-acquired hypernatremia, which was associated with explicitly higher signs of inflammation and ongoing catabolism as well as a prolonged ICU length of stay. Catabolism was discriminated better by the urea generation rate and the urea-to-creatinine ratio than by serum albumin concentration. An assignable cause for hypernatremia was the urea-induced osmotic diuresis. When dealing with ICU patients requiring prolonged treatment, hypernatremia should at least trigger thoughts on PICS as a contributing factor. In this regard, the urea-to-creatinine ratio is an easily accessible biomarker for catabolism.
登录
查看更多内容
影响因子：
38.9
作者：
Funk, Georg-Christian;Lindner, Gregor;Metnitz, Philipp G. H.
通讯作者：
Metnitz, Philipp G. H.
DOI：
10.1111/j.1365-2362.1989.tb00206.x
发表时间：
1989-04-01
影响因子：
5.5
作者：
KOMJATI, M;KASTNER, G;BRATUSCHMARRAIN, P
通讯作者：
BRATUSCHMARRAIN, P
影响因子：
38.9
作者：
Metnitz, PGH;Moreno, RP;Almeida, E;Jordan, B;Bauer, P;Campos, RA;Iapichino, G;Edbrooke, D;Capuzzo, M;Le Gall, JR
通讯作者：
Le Gall, JR
血清白蛋白的术后减少是否是大腹部手术后并发症的早期预测指标？在欧洲中心进行的一项前瞻性队列研究。
影响因子：
2.9
作者：
Labgaa I;Joliat GR;Kefleyesus A;Mantziari S;Schäfer M;Demartines N;Hübner M
通讯作者：
Hübner M
影响因子：
38.9
作者：
Haines, Ryan W.;Zolfaghari, Parjam;Prowle, John R.
通讯作者：
Prowle, John R.