■当前指南建议限制严重低钠血症患者的矫正率,以避免严重的神经系统并发症,例如渗透性脱髓鞘综合征(ODS)。然而,公布的数据相互矛盾。我们旨在评估严重低钠血症患者快速钠校正与ODS之间的关系。
■我们搜索了PubMed,Embase,Scopus,WebofScience,和Cochrane中央受控试验登记册从开始到2023年11月。主要结局是ODS,次要结局是住院死亡率和住院时间。
■我们确定了7项队列研究,涉及6,032例重度低钠血症成人患者。29名患者出现了ODS,导致发病率为0.48%。17名患者(61%)在入院的第一个或任何24小时内快速校正了血清钠。与有限的钠校正率相比,快速的钠校正率与ODS风险增加相关(RR,3.91[95%CI,1.17至13.04];I2=44.47%;p=0.03)。然而,快速的钠校正率将住院死亡率的风险降低了约50%(RR,0.51[95%CI,0.39至0.66];I2=0.11%;p<0.001)和1.3天的住院时间(平均差,-1.32[95%CI,-2.54至-0.10];I2=71.47%;p=0.03)。
■快速校正血清钠可能会增加严重低钠血症住院患者的ODS风险。然而,无论血清钠校正率如何,患者都可能发生ODS。
UNASSIGNED: Current guidelines recommend limiting the rate of correction in patients with severe hyponatremia to avoid severe neurologic complications such as osmotic demyelination syndrome (ODS). However, published data have been conflicting. We aimed to evaluate the association between rapid sodium correction and ODS in patients with severe hyponatremia.
UNASSIGNED: We searched PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to November 2023. The primary outcome was ODS and the secondary outcomes were in-hospital mortality and length of hospital stay.
UNASSIGNED: We identified 7 cohort studies involving 6,032 adult patients with severe hyponatremia. Twenty-nine patients developed ODS, resulting in an incidence rate of 0.48%. Seventeen patients (61%) had a rapid correction of serum sodium in the first or any 24-hour period of admission. Compared with a limited rate of sodium correction, a rapid rate of sodium correction was associated with an increased risk of ODS (RR, 3.91 [95% CI, 1.17 to 13.04]; I2 = 44.47%; p = 0.03). However, a rapid rate of sodium correction reduced the risk of in-hospital mortality by approximately 50% (RR, 0.51 [95% CI, 0.39 to 0.66]; I2 = 0.11%; p < 0.001) and the length of stay by 1.3 days (Mean difference, -1.32 [95% CI, -2.54 to -0.10]; I2 = 71.47%; p = 0.03).
UNASSIGNED: Rapid correction of serum sodium may increase the risk of ODS among patients hospitalized with severe hyponatremia. However, ODS may occur in patients regardless of the rate of serum sodium correction.