Prognostic consequences of borderline dysnatremia pay attention to minimal serum sodium change 英文参考文献.docVIP

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Prognostic consequences of borderline dysnatremia pay attention to minimal serum sodium change 英文参考文献.doc

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Prognostic consequences of borderline dysnatremia pay attention to minimal serum sodium change 英文参考文献

Darmonetal.CriticalCare2013,17:R12 /content/17/1/R12 RESEARCH OpenAccess Prognosticconsequencesofborderline dysnatremia:payattentiontominimalserum sodiumchange MichaelDarmon1*,EricDiconne1,BertrandSouweine2,StéphaneRuckly3,4,ChristopheAdrie5,ElieAzoulay6, ChristopheClec’h7,Ma?téGarrouste-Orgeas8,CaroleSchwebel4,DanyGoldgran-Toledano9,HatemKhallel10, Anne-SylvieDumenil11,SamirJamali12,ChristineCheval13,BernardAllaouchiche14,FabriceZeni1and Jean-Fran?oisTimsit3,4 Abstract Introduction:Toassesstheprevalenceofdysnatremia,includingborderlinechangesinserumsodium concentration,andtoestimatetheimpactofthesedysnatremiaonmortalityafteradjustmentforconfounders. Methods:Observationalstudyonaprospectivedatabasefedby13intensivecareunits(ICUs).Unselectedpatients withICUstaylongerthan48hwereenrolledovera14-yearperiodwereincludedinthisstudy.Mildtosevere hyponatremiaweredefinedasserumsodiumconcentration135,130,and125mmol/Lrespectively.Mildto severehypernatremiaweredefinedasserumsodiumconcentration145,150,and155mmol/Lrespectively. Borderlinehyponatremiaandhypernatremiaweredefinedasserumsodiumconcentrationbetween135and137 mmol/Lor143and145respectively. Results:Atotalof11,125patientswereincludedinthisstudy.Amongthesepatients,3,047(27.4%)hadmildto severehyponatremiaatICUadmission,2,258(20.3%)hadborderlinehyponatremiaatICUadmission,1,078(9.7%) hadborderlinehypernatremiaand877(7.9%)hadmildtoseverehypernatremia.Afteradjustmentforconfounder, bothmoderateandseverehyponatremia(subdistributionhazardratio(sHR)1.82,95%CI1.002to1.395and1.27, 95%CI1.01to1.60respectively)wereassociatedwithday-30mortality.Similarly,mild,moderateandsevere hypernatremia(sHR1.34,95%CI1.14to1.57;1.51,95%CI1.15to1.99;and2.64,95%CI2.00to3.81respectively) wereindependentlyassociatedwithday-30mortality. Conclusions:One-thirdofcriticallyillpatientshadamildtomoderatedysnatremiaatICUadmission.Dysnatremia, includingmildchangesinserumsodiumconcentration,isanindependentriskfactorforhospitalmortalityand shouldnotbeneglected. Intr