Effects of correction rate for severe hyponatremia in the intensive care unit on patient outcomes

被引:8
作者
Kinoshita, Takahiro [1 ]
Mlodzinski, Eric [2 ,8 ]
Xiao, Qian [1 ]
Sherak, Raphael [1 ,3 ]
Raines, Nathan H. [4 ]
Celi, Leo A. [5 ,6 ,7 ]
机构
[1] Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA
[2] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA
[3] Yale New Haven Hosp, Dept Emergency Med, New Haven, CT 06510 USA
[4] Beth Israel Deaconess Med Ctr, Div Nephrol, Dept Med, Boston, MA 02115 USA
[5] MIT, Lab Computat Physiol, Harvard MIT Hlth Sci & Technol, MIT Crit Data, Cambridge, MA 02139 USA
[6] Beth Israel Deaconess Med Ctr, Dept Med, Div Pulm Crit Care & Sleep Med, Boston, MA 02215 USA
[7] Harvard TH Chan Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
[8] Univ Calif San Diego, Div Pulm Crit Care Sleep & Physiol, La Jolla, CA 92037 USA
关键词
Hyponatremia; Sodium; Electrolytes; Intensive care units; Nephrology; Mortality; RAPID CORRECTION;
D O I
10.1016/j.jcrc.2023.154325
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: Limited evidence exists regarding outcomes associated with different correction rates of severe hyponatremia.Materials and methods: This retrospective cohort analysis employed a multi-center ICU database to identify pa-tients with sodium <= 120 mEq/L during ICU admission. We determined correction rates over the first 24 h and categorized them as rapid (> 8 mEq/L/day) or slow (<= 8 mEq/L/day). The primary outcome was in-hospital mortality. Secondary outcomes included hospital-free days, ICU-free days, and neurological complications. We used inverse probability weighting for confounder adjustment.Results: Our cohort included 1024 patients; 451 rapid and 573 slow correctors. Rapid correction was associated with lower in-hospital mortality (absolute difference:-4.37%; 95% CI,-8.47 to-0.26%), longer hospital-free days (1.80 days; 95% CI, 0.82 to 2.79 days), and longer ICU-free days (1.16 days; 95% CI, 0.15 to 2.17 days). There was no significant difference in neurological complications (2.31%; 95% CI,-0.77 to 5.40%).Conclusion: Rapid correction (>8 mEq/L/day) of severe hyponatremia within the first 24 h was associated with lower in-hospital mortality and longer ICU and hospital-free days without an increase in neurological compli-cation. Despite major limitations, including the inability to identify the chronicity of hyponatremia, the results have important implications and warrant prospective studies.
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页数:8
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共 29 条
  • [1] Primary care:: Hyponatremia.
    Adrogué, HJ
    Madias, NE
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (21) : 1581 - 1589
  • [2] Chronic hyponatremic encephalopathy in postmenopausal women - Association of therapies with morbidity and mortality
    Ayus, JC
    Arieff, AI
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 281 (24): : 2299 - 2304
  • [3] Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study
    Bai, Anthony D.
    Dai, Cathy
    Srivastava, Siddhartha
    Smith, Christopher A.
    Gill, Sudeep S.
    [J]. BMC HEALTH SERVICES RESEARCH, 2019, 19 (01)
  • [4] Incidence, causes and prognostic factors of hyponatremia in an intensive care unit
    Bennani, SL
    Abouqal, R
    Zeggwagh, AA
    Madani, N
    Abidi, K
    Zekraoui, A
    Kerkeb, O
    [J]. REVUE DE MEDECINE INTERNE, 2003, 24 (04): : 224 - 229
  • [5] CENTRAL PONTINE MYELINOLYSIS AND PONTINE LESIONS AFTER RAPID CORRECTION OF HYPONATREMIA - A PROSPECTIVE MAGNETIC-RESONANCE-IMAGING STUDY
    BRUNNER, JE
    REDMOND, JM
    HAGGAR, AM
    KRUGER, DF
    ELIAS, SB
    [J]. ANNALS OF NEUROLOGY, 1990, 27 (01) : 61 - 66
  • [6] Hyponatremia Improvement Is Associated with a Reduced Risk of Mortality: Evidence from a Meta-Analysis
    Corona, Giovanni
    Giuliani, Corinna
    Verbalis, Joseph G.
    Forti, Gianni
    Maggi, Mario
    Peri, Alessandro
    [J]. PLOS ONE, 2015, 10 (04):
  • [7] Intensive care unit quality improvement: A "how-to" guide for the interdisciplinary team
    Curtis, JR
    Cook, DJ
    Wall, RJ
    Angus, DC
    Bion, J
    Kacmarek, R
    Kane-Gill, SL
    Kirchhoff, KT
    Levy, M
    Mitchell, PH
    Moreno, R
    Pronovost, P
    Puntillo, K
    [J]. CRITICAL CARE MEDICINE, 2006, 34 (01) : 211 - 218
  • [8] INFLUENCE OF EARLY DYSNATREMIA CORRECTION ON SURVIVAL OF CRITICALLY ILL PATIENTS
    Darmon, Michael
    Pichon, Matthias
    Schwebel, Carole
    Ruckly, Stephane
    Adrie, Christophe
    Haouache, Hakim
    Azoulay, Elie
    Bouadma, Lila
    Clec'h, Christophe
    Garrouste-Orgeas, Maite
    Souweine, Bertrand
    Goldgran-Toledano, Dany
    Khallel, Hatem
    Argaud, Laurent
    Dumenil, Anne-Sylvie
    Jamali, Samir
    Allaouchiche, Bernard
    Zeni, Fabrice
    Timsit, Jean-Francois
    [J]. SHOCK, 2014, 41 (05): : 394 - 399
  • [9] Incidence and prognosis of dysnatremias present on ICU admission
    Funk, Georg-Christian
    Lindner, Gregor
    Druml, Wilfred
    Metnitz, Barbara
    Schwarz, Christoph
    Bauer, Peter
    Metnitz, Philipp G. H.
    [J]. INTENSIVE CARE MEDICINE, 2010, 36 (02) : 304 - 311
  • [10] Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia
    George, Jason C.
    Zafar, Waleed
    Bucaloiu, Ion Dan
    Chang, Alex R.
    [J]. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2018, 13 (07): : 984 - 992