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Active management of severe hyponatraemia is associated with improved mortality.

积极处理严重低钠血症与死亡率提高有关。

  • 影响因子:5.04
  • DOI:10.1530/EJE-20-0577
  • 作者列表:"Garrahy A","Cuesta M","Murphy B","O'Reilly MW","Tormey WP","Sherlock M","Thompson CJ
  • 发表时间:2021-01-01
Abstract

Objective:Severe hyponatraemia (plasma sodium concentration, pNa <120 mmol/L) is reported to be associated with mortality rates as high as 50%. Although there are several international guidelines for the management of severe hyponatraemia, there are few data on the impact of treatment. Design and methods:We have longitudinally reviewed rates of specialist input, active management of hyponatraemia, treatment outcomes and mortality rates in patients with severe hyponatraemia (pNa <120 mmol/L) in 2005, 2010 and 2015, and compared the recent mortality rate with that of patients with pNa 120-125 mmol/L. Results:Between 2005 and 2010 there was a doubling in the rate of specialist referral (32 to 68%, P = 0.003) and an increase in the use of active management of hyponatraemia in patients with pNa <120 mmol/L (63 to 88%, P = 0.02), associated with a reduction in mortality from 51 to 15% (P < 0.001). The improved rates of intervention were maintained between 2010 and 2015, but there was no further reduction in mortality. When data from all three reviews were pooled, specialist consultation in patients with pNa <120 mmol/L was associated with a 91% reduction in mortality risk, RR 0.09 (95% CI: 0.03-0.26), P < 0.001. Log-rank testing on in-hospital survival in 2015 found no significant difference between patients with pNa <120 mmol/L and pNa 120-125 mmol/L (P = 0.56). Conclusion:Dedicated specialist input and active management of severe hyponatraemia are associated with a reduction in mortality, to rates comparable with moderate hyponatraemia.

摘要

目的: 据报道,严重低钠血症 (血浆钠浓度,pNa <120 mmol/L) 与高达50% 的死亡率相关。虽然有几个国际指南用于严重低钠血症的管理,但关于治疗影响的数据很少。 设计和方法: 我们纵向回顾了2005年、120年和2010年严重低钠血症 (pNa <2015 mmol/L) 患者的专家投入、低钠血症的积极管理、治疗结果和死亡率,比较pNa 120 ~ 125 mmol/L患者的近期死亡率。 结果: 在2005至2010之间,pNa <68% mmol/L患者的专科转诊率增加了一倍 (32至0.003,P = 120),低钠血症积极管理的使用增加 (63至88%,P = 0.02),与死亡率从51下降到15%(P <0.001)。在2010年至2015年期间,干预率有所提高,但死亡率没有进一步降低。当合并所有三个综述的数据时,pNa <120 mmol/L患者的专家咨询与死亡风险降低91% 相关,RR 0.09 (95% CI: 0.03-0.26),P <0.001。2015年住院生存率的时序检验发现,pNa <120 mmol/L和pNa 120-125 mmol/L患者之间无显著差异 (P = 0.56)。 结论: 专门的专家投入和积极管理重度低钠血症与死亡率降低相关,与中度低钠血症相当。

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