Ahmad Nasser, Anis Chaba, Kevin B Laupland, Mahesh Ramanan, Alexis Tabah, Antony G Attokaran, Aashish Kumar, James McCullough, Kiran Shekar, Peter Garrett, Philippa McIlroy, Stephen Luke, Siva Senthuran, Rinaldo Bellomo, Kyle C White
{"title":"icu获得性高钠血症：患病率、患者特征、发展轨迹、危险因素和结局。","authors":"Ahmad Nasser, Anis Chaba, Kevin B Laupland, Mahesh Ramanan, Alexis Tabah, Antony G Attokaran, Aashish Kumar, James McCullough, Kiran Shekar, Peter Garrett, Philippa McIlroy, Stephen Luke, Siva Senthuran, Rinaldo Bellomo, Kyle C White","doi":"10.1016/j.ccrj.2024.09.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Knowledge of intensive care unit (ICU) acquired hypernatremia (ICU-AH) has been hampered by the absence of granular data and confounded by variable definitions and inclusion criteria.</p><p><strong>Design: </strong>Multicentre retrospective cohort study.</p><p><strong>Setting: </strong>Twelve ICUs in Queensland (QLD), Australia.</p><p><strong>Participants: </strong>Adult patients admitted to ICU from 2015 to 2021. Only the first ICU admission was considered, and we categorised patients into mild (146-150 mmol·L<sup>-1</sup>), moderate (151-155 mmol·L<sup>-1</sup>) and severe (>155 mmol·L<sup>-1</sup>) ICU-acquired hypernatremia.</p><p><strong>Main outcome measure: </strong>We aimed to study the prevalence of ICU-AH, patient characteristics, trajectory, risk factors, and outcomes.</p><p><strong>Results: </strong>Data from 55,255 ICU admissions were included in the analysis, of which 4146 (7.5 %) patients had ICU-AH. These were subcategorised into mild (n = 2,670, 4.8 %), moderate (n = 1,073, 1.9 %) and severe (n = 403, 0.73 %) forms. Median time to diagnosis was 4 (2-6) d after ICU admission, while median time to peak serum sodium level was 5 (3-8) d. The median maximum sodium level across the cohort was 149 (147-152) mmol·L<sup>-1</sup>. The sodium correction rate was 1 mmol·L<sup>-1</sup> per day, taking a median of 3 d (1-5) for sodium levels to return below 145 mmol·L<sup>-1</sup>. APACHE III score, invasive ventilation, fever, and diuretic use on the day before hypernatremia were independent risk factors for moderate or severe ICU-AH. After adjusting for confounders, all levels of hypernatremia were independently associated with an increased risk of 30-d in-hospital mortality.</p><p><strong>Conclusions: </strong>In a large multicentric study of critically ill patients, ICU-acquired hypernatremia occurred in one in eight admissions after a median of four days in the ICU and was preceded by identifiable and modifiable risk factors. If severe, its correction was slow, and normalisation was delayed. After adjusting for other factors, all levels of hypernatremia were an independent risk factor for 30-d in-hospital mortality.</p>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"303-310"},"PeriodicalIF":1.4000,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704424/pdf/","citationCount":"0","resultStr":"{\"title\":\"ICU-acquired hypernatremia: Prevalence, patient characteristics, trajectory, risk factors, and outcomes.\",\"authors\":\"Ahmad Nasser, Anis Chaba, Kevin B Laupland, Mahesh Ramanan, Alexis Tabah, Antony G Attokaran, Aashish Kumar, James McCullough, Kiran Shekar, Peter Garrett, Philippa McIlroy, Stephen Luke, Siva Senthuran, Rinaldo Bellomo, Kyle C White\",\"doi\":\"10.1016/j.ccrj.2024.09.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Knowledge of intensive care unit (ICU) acquired hypernatremia (ICU-AH) has been hampered by the absence of granular data and confounded by variable definitions and inclusion criteria.</p><p><strong>Design: </strong>Multicentre retrospective cohort study.</p><p><strong>Setting: </strong>Twelve ICUs in Queensland (QLD), Australia.</p><p><strong>Participants: </strong>Adult patients admitted to ICU from 2015 to 2021. Only the first ICU admission was considered, and we categorised patients into mild (146-150 mmol·L<sup>-1</sup>), moderate (151-155 mmol·L<sup>-1</sup>) and severe (>155 mmol·L<sup>-1</sup>) ICU-acquired hypernatremia.</p><p><strong>Main outcome measure: </strong>We aimed to study the prevalence of ICU-AH, patient characteristics, trajectory, risk factors, and outcomes.</p><p><strong>Results: </strong>Data from 55,255 ICU admissions were included in the analysis, of which 4146 (7.5 %) patients had ICU-AH. These were subcategorised into mild (n = 2,670, 4.8 %), moderate (n = 1,073, 1.9 %) and severe (n = 403, 0.73 %) forms. Median time to diagnosis was 4 (2-6) d after ICU admission, while median time to peak serum sodium level was 5 (3-8) d. The median maximum sodium level across the cohort was 149 (147-152) mmol·L<sup>-1</sup>. The sodium correction rate was 1 mmol·L<sup>-1</sup> per day, taking a median of 3 d (1-5) for sodium levels to return below 145 mmol·L<sup>-1</sup>. APACHE III score, invasive ventilation, fever, and diuretic use on the day before hypernatremia were independent risk factors for moderate or severe ICU-AH. After adjusting for confounders, all levels of hypernatremia were independently associated with an increased risk of 30-d in-hospital mortality.</p><p><strong>Conclusions: </strong>In a large multicentric study of critically ill patients, ICU-acquired hypernatremia occurred in one in eight admissions after a median of four days in the ICU and was preceded by identifiable and modifiable risk factors. If severe, its correction was slow, and normalisation was delayed. After adjusting for other factors, all levels of hypernatremia were an independent risk factor for 30-d in-hospital mortality.</p>\",\"PeriodicalId\":49215,\"journal\":{\"name\":\"Critical Care and Resuscitation\",\"volume\":\"26 4\",\"pages\":\"303-310\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-11-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704424/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care and Resuscitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ccrj.2024.09.003\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care and Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ccrj.2024.09.003","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
ICU-acquired hypernatremia: Prevalence, patient characteristics, trajectory, risk factors, and outcomes.
Objective: Knowledge of intensive care unit (ICU) acquired hypernatremia (ICU-AH) has been hampered by the absence of granular data and confounded by variable definitions and inclusion criteria.
Design: Multicentre retrospective cohort study.
Setting: Twelve ICUs in Queensland (QLD), Australia.
Participants: Adult patients admitted to ICU from 2015 to 2021. Only the first ICU admission was considered, and we categorised patients into mild (146-150 mmol·L-1), moderate (151-155 mmol·L-1) and severe (>155 mmol·L-1) ICU-acquired hypernatremia.
Main outcome measure: We aimed to study the prevalence of ICU-AH, patient characteristics, trajectory, risk factors, and outcomes.
Results: Data from 55,255 ICU admissions were included in the analysis, of which 4146 (7.5 %) patients had ICU-AH. These were subcategorised into mild (n = 2,670, 4.8 %), moderate (n = 1,073, 1.9 %) and severe (n = 403, 0.73 %) forms. Median time to diagnosis was 4 (2-6) d after ICU admission, while median time to peak serum sodium level was 5 (3-8) d. The median maximum sodium level across the cohort was 149 (147-152) mmol·L-1. The sodium correction rate was 1 mmol·L-1 per day, taking a median of 3 d (1-5) for sodium levels to return below 145 mmol·L-1. APACHE III score, invasive ventilation, fever, and diuretic use on the day before hypernatremia were independent risk factors for moderate or severe ICU-AH. After adjusting for confounders, all levels of hypernatremia were independently associated with an increased risk of 30-d in-hospital mortality.
Conclusions: In a large multicentric study of critically ill patients, ICU-acquired hypernatremia occurred in one in eight admissions after a median of four days in the ICU and was preceded by identifiable and modifiable risk factors. If severe, its correction was slow, and normalisation was delayed. After adjusting for other factors, all levels of hypernatremia were an independent risk factor for 30-d in-hospital mortality.
期刊介绍：
ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.
The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world.
The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.
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