基于倾向性评分匹配法的老年患者重度低钠血症危险因素分析

Risk Factors of Severe Hyponatremia in Elderly Patients Based on Propensity Score Matching

目的分析老年患者重度低钠血症的危险因素。方法选取医院2020年1月至2022年12月收治的老年(≥60岁)住院患者7608例,依据《2014欧洲低钠血症诊疗指南》分为重度低钠血症组(76例)和非重度低钠血症组(7532例),采用倾向性评分匹配法对两组患者进行1∶2匹配,采用单因素分析法分析老年患者重度低钠血症的危险因素,并对有统计学差异的变量进行Logistic多因素回归分析。结果倾向性评分匹配成功223例患者,其中重度低钠血症组75例,非重度低钠血症组148例。单因素分析结果显示,与非重度低钠血症组比较,重度低钠血症组危重症及使用利尿剂、非甾体抗炎药、利奈唑胺/环磷酰胺/卡马西平患者的重度低钠血症发生率显著升高(P<0.05)。Logistic多因素回归分析结果显示,老年患者重度低钠血症的危险因素为危重症(P<0.001)、使用利尿剂(P=0.003)、使用非甾体抗炎药(P=0.002)。结论对于危重症、长期使用利尿剂和非甾体抗炎药的老年患者,需密切关注其重度低钠血症的发生风险。

Objective To analyze the risk factors of severe hyponatremia in elderly patients.Methods A total of 7608 elderly(≥60 years old)inpatients admitted to the hospital from January 2020 to December 2022 were selected.According to the 2014 European Guidelines for the Diagnosis and Treatment of Hyponatremia,they were divided into the severe hyponatremia group(76 cases)and the non-severe hyponatremia group(7532 cases).The patients in the two groups were matched by propensity score matching(PSM)with a ratio of 1∶2.Univariate analysis was used to analyze the risk factors for severe hyponatremia in elderly patients,and multivariate Logistic regression analysis was performed on variables with statistical differences.Results A total of 223 patients were successfully matched by PSM,including 75 cases in the severe hyponatremia group and 148 cases in the non-severe hyponatremia group.The results of the univariate analysis showed that compared with that in the non-severe hyponatremia group,the incidence of severe hyponatremia in patients with critical and serious illness,patients treated with diuretics,nonsteroidal anti-inflammatory drugs(NSAIDs),and linezolid/cyclophosphamide/carbamazepine in the severe hyponatremia group(P<0.05).The results of the multivariate Logistic regression analysis showed that critical and serious illness(P<0.001),use of diuretics(P=0.003)and NSAIDs(P=0.002)were risk factors of severe hyponatremia.Conclusion For elderly patients with risk factors such as critical and serious illness,use of diuretics and NSAIDs,close attention should be paid to the risk of severe hyponatremia.