严重低钠血症住院成人的纠正率和临床结果:系统综述与元分析》。

IF 22.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Juan Carlos Ayus, Michael L Moritz, Nora Angélica Fuentes, Jhonatan R Mejia, Juan Martín Alfonso, Saeha Shin, Michael Fralick, Agustín Ciapponi
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引用次数: 0

摘要

重要性:低钠血症治疗指南建议在最初 24 小时内限制对严重低钠血症的纠正,以防止渗透性脱髓鞘综合征(ODS)。最近的证据表明,较慢的纠正速度与死亡率增加有关:评估严重低钠血症住院成人钠纠正率与死亡率的关系:我们检索了 MEDLINE、Embase、Cochrane 图书馆、LILACS、Web of Science、CINAHL 和国际大会论文集中 2013 年 1 月至 2023 年 10 月间发表的研究:评估快速(每 24 小时≥8-10 毫克/升)与慢速(数据提取与合成:一对审稿人(N.A.F.、J.R.M.、J.M.A.、A.C.)独立审阅研究、提取数据,并使用 ROBINS-I 评估每项纳入研究的偏倚风险。研究遵循 Cochrane 方法、PRISMA 报告指南和 GRADE(建议评估、发展和评价分级)方法来评定证据的确定性。采用随机效应模型对数据进行汇总:主要结果和测量指标:主要结果为住院和 30 天死亡率,次要结果为住院时间(LOS)和 ODS:共纳入了 16 项队列研究,涉及 11 811 名严重低钠血症患者(平均 [SD] 年龄为 68.22 [6.88] 岁;在 15 项报告性别的研究中,女性占 56.7%)。中度确定性证据显示,快速纠正与缓慢纠正和极慢纠正相比,每1000例治疗患者的院内死亡人数分别减少了32例(几率比为0.67;95% CI为0.55-0.82)和221例(几率比为0.29;95% CI为0.11-0.79)。低确定性证据表明,与慢速矫正和极慢速矫正相比,快速矫正可使每千名接受治疗的患者在30天内死亡人数分别减少61人(风险比为0.55;95% CI为0.45-0.67)和134人(风险比为0.35;95% CI为0.28-0.44),住院时间分别缩短1.20天(95% CI为0.51-1.89)和3.09天(95% CI为1.21-4.94)。快速矫正与ODS风险的统计学显著增加无关:在这项系统回顾和荟萃分析中,与快速纠正相比,严重低钠血症的慢速纠正和极慢速纠正与死亡率和住院时间风险的增加有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia: A Systematic Review and Meta-Analysis.

Importance: Hyponatremia treatment guidelines recommend limiting the correction of severe hyponatremia during the first 24 hours to prevent osmotic demyelination syndrome (ODS). Recent evidence suggests that slower rates of correction are associated with increased mortality.

Objective: To evaluate the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.

Data sources: We searched MEDLINE, Embase, the Cochrane Library, LILACS, Web of Science, CINAHL, and international congress proceedings for studies published between January 2013 and October 2023.

Study selection: Comparative studies assessing rapid (≥8-10 mEq/L per 24 hours) vs slow (<8 or 6-10 mEq/L per 24 hours) and very slow (<4-6 mEq/L per 24 hours) correction of severe hyponatremia (serum sodium <120 mEq/L or <125 mEq/L plus severe symptoms) in hospitalized patients.

Data extraction and synthesis: Pairs of reviewers (N.A.F., J.R.M., J.M.A., A.C.) independently reviewed studies, extracted data, and assessed each included study's risk of bias using ROBINS-I. Cochrane methods, PRISMA reporting guidelines, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to rate the certainty of evidence were followed. Data were pooled using a random-effects model.

Main outcomes and measures: Primary outcomes were in-hospital and 30-day mortality, and secondary outcomes were hospital length of stay (LOS) and ODS.

Results: Sixteen cohort studies involving a total of 11 811 patients with severe hyponatremia were included (mean [SD] age, 68.22 [6.88] years; 56.7% female across 15 studies reporting sex). Moderate-certainty evidence showed that rapid correction was associated with 32 (odds ratio, 0.67; 95% CI, 0.55-0.82) and 221 (odds ratio, 0.29; 95% CI, 0.11-0.79) fewer in-hospital deaths per 1000 treated patients compared with slow and very slow correction, respectively. Low-certainty evidence suggested that rapid correction was associated with 61 (risk ratio, 0.55; 95% CI, 0.45-0.67) and 134 (risk ratio, 0.35; 95% CI, 0.28-0.44) fewer deaths per 1000 treated patients at 30 days and with a reduction in LOS of 1.20 (95% CI, 0.51-1.89) and 3.09 (95% CI, 1.21-4.94) days, compared with slow and very slow correction, respectively. Rapid correction was not associated with a statistically significant increased risk of ODS.

Conclusions and relevance: In this systematic review and meta-analysis, slow correction and very slow correction of severe hyponatremia were associated with an increased risk of mortality and hospital LOS compared to rapid correction.

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来源期刊
JAMA Internal Medicine
JAMA Internal Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
43.50
自引率
1.30%
发文量
371
期刊介绍: JAMA Internal Medicine is an international, peer-reviewed journal committed to advancing the field of internal medicine worldwide. With a focus on four core priorities—clinical relevance, clinical practice change, credibility, and effective communication—the journal aims to provide indispensable and trustworthy peer-reviewed evidence. Catering to academics, clinicians, educators, researchers, and trainees across the entire spectrum of internal medicine, including general internal medicine and subspecialties, JAMA Internal Medicine publishes innovative and clinically relevant research. The journal strives to deliver stimulating articles that educate and inform readers with the latest research findings, driving positive change in healthcare systems and patient care delivery. As a member of the JAMA Network, a consortium of peer-reviewed medical publications, JAMA Internal Medicine plays a pivotal role in shaping the discourse and advancing patient care in internal medicine.
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