Systematic review and meta-analysis of the treatment of hypernatremia in adult hospitalized patients: impact on mortality, morbidity, and treatment-related side effects

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE Journal of critical care Pub Date : 2025-06-01 Epub Date: 2025-01-06 DOI:10.1016/j.jcrc.2024.155012

Nuanprae Kitisin , Nattaya Raykateeraroj , Yukiko Hikasa , Larissa Bianchini , Nuttapol Pattamin , Anis Chaba , Akinori Maeda , Sofia Spano , Glenn Eastwood , Kyle White , Rinaldo Bellomo

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Abstract

Background

Hypernatremia is relatively common in acutely ill patients and associated with mortality. Guidelines recommend a slow rate of correction (≤ 0.5 mmol/L per hour). However, a faster correction rate may be safe and improve outcomes.

Objectives

To evaluate the impact of sodium correction rates on mortality and hospital length of stay and to assess types of hypernatremia treatment and treatment side effects.

Methods

We conducted a systematic review and meta-analysis according to PRISMA guidelines, searching Ovid MEDLINE, Embase, and CENTRAL databases from inception to August 2024. Studies reporting sodium correction rates and clinical outcomes in hospitalized adults were included. A random-effects meta-analysis assessed mortality and hospital length of stay, with subgroup analyses exploring correction timing and severity. Treatment method and side effects were analyzed qualitatively.

Results

We reviewed 4445 articles and included 12 studies. Faster correction rates (> 0.5 mmol/L/h) overall showed no significant change in mortality and a high level of heterogeneity (OR 0.68, 95 % CI: 0.38–1.24, I² = 95 %). However, subgroup analyses found significantly lower mortality with faster correction of hypernatremia at the time of hospital admission (OR 0.48, 95 % CI: 0.35–0.68, I² = 2 %), with fast correction within the first 24 h of diagnosis (OR 0.48, 95 % CI: 0.31–0.73, I² = 65 %), and for severe hypernatremia (OR 0.55, 95 % CI: 0.33–0.92, I² = 79 %). There was no significant different in hospital length of stay by correction rate. No major neurological complications were reported when the correction rate was < 1 mmol/L/h.

Conclusion

Faster sodium correction appears safe and may benefit patients with severe admission-related hypernatremia, particularly within the first 24 h. Further studies are needed to refine correction protocols.

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成人住院患者高钠血症治疗的系统回顾和荟萃分析：对死亡率、发病率和治疗相关副作用的影响

背景：高钠血症在急症患者中较为常见，并与死亡率相关。指南建议缓慢校正（≤0.5 mmol/L /小时）。然而，更快的矫正率可能是安全的，并且可以改善结果。目的评价钠矫正率对高钠血症患者死亡率和住院时间的影响，并评价高钠血症的治疗类型和治疗副作用。方法根据PRISMA指南，检索Ovid MEDLINE、Embase和CENTRAL数据库，自成立至2024年8月进行系统评价和meta分析。研究报告了住院成人的钠矫正率和临床结果。随机效应荟萃分析评估了死亡率和住院时间，亚组分析探讨了纠正时间和严重程度。对治疗方法及不良反应进行定性分析。结果纳入12项研究，共纳入4445篇文献。更快的校正率(>；0.5 mmol/L/h)总体上显示死亡率无显著变化，异质性较高（OR 0.68, 95% CI: 0.38-1.24, I2 = 95%）。然而，亚组分析发现，入院时快速纠正高钠血症（OR 0.48, 95% CI: 0.35-0.68, I2 = 2%）、诊断后24小时内快速纠正高钠血症（OR 0.48, 95% CI: 0.31-0.73, I2 = 65%）和严重高钠血症（OR 0.55, 95% CI: 0.33-0.92, I2 = 79%）的死亡率显著降低。两组住院时间和矫正率差异无统计学意义。当矫正率为<；1更易与L / h。结论：更快的钠纠正似乎是安全的，并且可能有利于严重入院相关高钠血症患者，特别是在最初24小时内。需要进一步的研究来完善纠正方案。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.