高钠血症对重症监护病房患者预后影响的荟萃分析

The influence of hypernatremia on mortality in intensive care unit patients： a Meta-analysis

目的 系统评价高钠血症在重症监护病房（ICU）的发生率及对ICU患者预后的影响.方法 检索PubMed、EMBASE、Cochrane Library及中国知网CNKI、万方数据库,收集2013年9月之前有关ICU患者并发高钠血症的观察性研究,采用STATA 12.0软件进行荟萃分析（Meta分析）.评价指标为高钠血症对ICU患者院内病死率和ICU病死率的影响.结果 最终符合纳入标准的文献有14篇,来自9个国家、449个ICU,共计365 103例患者.统计结果显示：ICU高钠血症的发生率为6.9％（25 326/365 103）;高钠血症患者的病死率为32.7％（8 291/25 326）,是非高钠血症患者的病死率[11.9％（40 588/339 777）]的2.75倍;其中高钠血症患者中医源性高钠血症患者的病死率为31.6％（3 790/11 976）,混合性高钠血症患者的病死率为33.7％（4 501/13 350）,两者相当.Meta分析显示,高钠血症为院内病死率的独立危险因素[相对危险度（RR）为1.86,95％可信区间（95％CI）为1.57 ～ 2.20],为ICU病死率的独立危险因素（RR为2.58,95％CI为2.00 ～ 3.33）,但研究的异质性较大.以研究例数（＞1 000例或≤1 000例）、ICU类型（外科ICU或未具体说明ICU种类）、研究类型（回顾性队列研究、前瞻性队列研究或病例对照研究）、高钠血症类型（医源性或混合性）进行亚组分析,均未找到异质性来源.漏斗图显示无发表偏倚.结论 高钠血症可明显增加ICU患者的病死率,为ICU患者死亡的独立危险因素.

Objective To evaluate the incidence of hypernatremia and its influence on mortality in intensive care unit （ICU） patients.Methods PubMed,EMBASE,Cochrane central registration of controlled trials,CNKI and Wanfang Data were searched,and relevant data of the study regarding hypernatremia in ICU patients published before September 2013 were retrieved.Meta analysis was conducted with STATA 12.0,and the effect of hypernatremia on hospital mortality and ICU mortality was evaluated.Results The pooled results from 14 articles from 449 ICU in 9 countries involving 365 103 patients showed that the morbidity rate of hypernatremia in ICU was 6.9％ （25 326/ 365 103）,and the mortality rate was 32.7％ （8 291/25 326）.The mortality of non-hypernatremic patients was 11.9％ （40 588/339 777）,but the mortality of hypernatremic patients was about 2.75 times higher than non-hypernatremic patients.In patients with hypernatremia,the mortality of iatrogenic hypernatremia was 31.6％ （3 790/11 976）,which was similar to that of non-iatrogenic hypernatremia [33.7％ （4 501/13 350）].Further Meta analysis showed that hypernatremia was an independent risk factor of hospital mortality [relative risk （RR） 1.86,95％ confidence interval （95％CI） 1.57-2.20],and ICU mortality （RR 2.58,95％CI 2.00-3.33）,but the heterogeneity was high.The source of heterogeneity was found with subgroup analysis according to sample size （＞ 1 000 cases or ≤ 1 000 cases）,ICU type （surgical ICU or other types）,study type （retrospective cohort study,prospective cohort study or case-control study）,hypernatremia type （iatrogenic hypernatremia or not）.Funnel plot showed no publication bias.Conclusion Hypernatremia could obviously raise the mortality rate in ICU patients,and it was an independent risk factor for critically ill patients.