Incidence, causes and prognostic factors of hyponatremia in an intensive care unit
Incidence, causes and prognostic factors of hyponatremia in an intensive care unit
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DOI：
10.1016/s0248-8663(02)00811-1
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发表时间：
2003-04-01
影响因子：
0.9
通讯作者：
Kerkeb, O
中科院分区：
文献类型：
--
作者：
Bennani, SL;Abouqal, R;Kerkeb, O
目的。-低钠血症的发生率未知，其原因是多方面的。更高的死亡率，特别是在重症监护病房，目前还无法解释。本文的目的是评估重症监护病房低钠血症的发生率，评估其原因，并找出预测预后的因素。-我们回顾了1996年1月至2000年2月在内科重症监护病房住院的所有患者，他们在入院时表现为低钠血症(<130mmo1/L)。我们排除了所有在医院出现获得性低钠血症的患者，或合并高血糖或甘露醇治疗的低钠血症。对数据进行单因素分析，然后进行多因素分析。-在研究期间，在2188名患者中确定了300名患者：发病率为13.7%，95%可信区间(95%CI)在9.8%至16.7%之间。低血容量性低钠血症占25.7%，高容量血症占23.7%，正常血容量血症占50.6%。住院死亡率为37.7%(95%可信区间：31.8%-42.3%)。在单因素分析中，有9项资料与较高的死亡率显著相关，但在多因素分析中，只有5项资料被确定为住院死亡率的独立预测因素：低钠血症、低钠血症、相对危险度(RR=2.10；95%CI：1.43~3.08；P<；0.001)、格拉斯哥评分9(RR=2.66；95%CI：1.25~5.66；P=0.01)、格拉斯哥评分9~14(RR=1.94；95%CI：1.31~2.88；休克(RR=1.8 0；95%CI：1.1 0~3.0 5；P=0.0 2)和血尿素浓度(RR=1.5 9；95%CI：1.0 8~2.34；P=0.0 2)。-低钠血症发生率高，等容血型占50%。死亡率在很大程度上与器官功能障碍有关，但低钠血症的严重程度仍然是死亡率的重要预测因素。(C)2003年版《爱思唯尔科学与医学》。版权所有。
Purpose. - The incidence of hyponatremia is unknown, their causes are multiple. The higher mortality, especially in intensive care units, is currently unexplained. The objective of this article is to evaluate the incidence of hyponatremia, to assess their causes and to identify predictors of prognosis in intensive care units.Methods. - We included retrospectively all patients admitted at department of medical intensive care unit between January 1996 and February 200 1, who presented at the admission, an hyponatremia (< 130 mmol/l). We excluded all patients who presented a hospital acquired hyponatremia, or hyponatremia associated with hyperglycemia > 13 mmol/l or with mannitol administration. Data were analysed by univariate methods, then by multivariate analysis.Results. - During the study period, 300 patients were identified among 2188: the incidence was 13.7% with 95% confidence interval (95% Cl) between 9.8% and 16.7%. Hypovolemic hyponatremia was observed in 25.7%, hypervolemic in 23.7% and normovolemic in 50.6%. In-hospital mortality was 37.7% (95% CI: 31.8% - 42.3%). Nine data were significantly associated with higher mortality in univariate analysis, but only 5 were identified as independant predictors of hospital mortality in multivariate analysis: hyponatremia < 125 mmol/l with a significant relative risk (RR) (RR = 2.10; 95% CI: 1.43-3.08; p < 0.001), Glasgow score < 9 (RR = 2.66; 95% CI: 1.25-5.66;p = 0.01), Glasgow score between 9 and 14 (RR = 1.94; 95% CI: 1.31-2.88; p < 0.001), shock (RR = 1.80; 95% CI: 1.10-3.05; p = 0.02) and blood urea concentration > 10 mmol/l (RR = 1.59; 95% CI : 1.08-2.34; p = 0.02).Conclusion. - The frequency of hyponatremia is high; the normovolemic type represented 50%. Mortality is linked, in greater part, to organs dysfunction, but the severity of hyponatremia remained a significant predictor of mortality. (C) 2003 Editions scientifiques et medicales Elsevier SAS. All rights reserved.