Incidence and prognosis of dysnatremias present on ICU admission
Incidence and prognosis of dysnatremias present on ICU admission
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DOI：
10.1007/s00134-009-1692-0
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发表时间：
2010-02-01
影响因子：
38.9
通讯作者：
Metnitz, Philipp G. H.
中科院分区：
文献类型：
--
作者：
Funk, Georg-Christian;Lindner, Gregor;Metnitz, Philipp G. H.
钠营养不良在入住重症监护室（ICU）的患者中很常见。ICU入院时钠平衡紊乱是否与死亡率增高独立相关尚不清楚。我们假设ICU入院时的血钠异常是危重患者死亡率增加的独立危险因素，我们对奥地利77个内科、外科和混合ICU进行了一项回顾性研究，数据库包括151，486名连续10年入院的成人大多数患者（114，170，75.4%）在ICU入院时钠水平正常（135 a千分之一货币符号Na a千分之一货币符号145 mmol/L）。临界低钠血症（130 a/1000货币符号Na < 135 mmol/L）、轻度低钠血症（125 a/1000货币符号Na < 130 mmol/L）和重度低钠血症（Na < 125 mmol/L）的发生率分别为13.8%、2.7%和1.2%。临界高钠血症（145 < Na <150 mmol/L）、轻度高钠血症（150 < Na <155 mmol/L）和重度高钠血症（Na > 155 mmol/L）的发生率分别为5.1%、1.2%和0.6%。所有类型和级别的血钠异常均与原始和风险调整后的住院死亡率增加相关。多因素Logistic回归分析显示，随着低钠血症和高钠血症严重程度的增加，独立的死亡风险增加。临界、轻度和重度低钠血症的比值比和95%置信区间（CI）分别为1.32（1.25-1.39）、1.89（1.71-2.09）和1.81（1.56-2.10）。临界、轻度和重度高钠血症的比值比和95%CI分别为1.48（1.36-1.61）、2.32（1.98-2.73）和3.64（2.88-4.61）。
Dysnatremias are common in patients admitted to the intensive care unit (ICU). Whether the presence of disorders of sodium balance on ICU admission is independently associated with excess mortality is unknown. We hypothesized that dysnatremias at the time of ICU admission are independent risk factors for increased mortality in critically ill patients.We conducted a retrospective study in 77 medical, surgical, and mixed ICUs in Austria, with a database of 151,486 adults admitted consecutively over a period of 10 years (1998-2007).Most patients (114,170, 75.4%) had normal sodium levels (135 a parts per thousand currency sign Na a parts per thousand currency sign 145 mmol/L) on ICU admission. The frequencies of borderline (130 a parts per thousand currency sign Na < 135 mmol/L), mild (125 a parts per thousand currency sign Na < 130 mmol/L), and severe hyponatremia (Na < 125 mmol/L) were 13.8%, 2.7%, and 1.2%, respectively. The frequencies of borderline (145 < Na a parts per thousand currency sign 150 mmol/L), mild (150 < Na a parts per thousand currency sign 155 mmol/L), and severe hypernatremia (Na > 155 mmol/L) were 5.1%, 1.2%, and 0.6%, respectively. All types and grades of dysnatremia were associated with increased raw and risk-adjusted hospital mortality ratios. Multiple logistic regression analysis showed an independent mortality risk rising with increasing severity of both hyponatremia and hypernatremia. Odds ratios and 95% confidence interval (CI) for borderline, mild, and severe hyponatremia were 1.32 (1.25-1.39), 1.89 (1.71-2.09), and 1.81 (1.56-2.10), respectively. Odds ratios and 95% CI for borderline, mild, and severe hypernatremia were 1.48 (1.36-1.61), 2.32 (1.98-2.73), and 3.64 (2.88-4.61), respectively.Our results suggest that both hypo- and hypernatremia present on admission to the ICU are independent risk factors for poor prognosis.