Kalça kırığı nedeniyle hastaneye başvuran hastalarda yatış sırasındaki hiponatremi insidansı ve mortaliteye etkisi
Abstract
yatırılan kırılgan yaşlı hastalarda yüksek morbidite ve mortalite ile ilişkilidir. Bu çalışmada, kalça kırığı nedeniyle hastaneye başvuran yaşlı hastalarda hiponatremi insidansının, hastanede yatış süresi, hastane içi ve 1 yıllık mortalite üzerine etkilerinin araştırılması amaçlandı.
Gereç ve Yöntem: Ocak-Aralık 2020 tarihleri arasında Ortopedi Kliniğine kalça kırığı nedeniyle başvuran 65 yaş üstü hastalar retrospektif olarak incelendi. Hastaların yaşı, cinsiyeti, kırık tipi, ek hastalıkları ve ASA fiziksel durumu kaydedildi. Hastaneye yatıştaki plazma Na, K ve Ca değerleri kaydedildi. Hiponatremik ve normonatremik hastalar demografik veriler, komorbiditeler, hastanede kalış süreleri, hastane içi ve 1 yıllık mortalite oranları açısından karşılaştırıldı.
Bulgular: Toplam 253 hastanın 52 (%20,5) 'sinde hastaneye yatışta hiponatremi mevcuttu. Hiponatremik ve normonatremik hastalarda demografik veriler benzerdi. Hiponatremi grubunda ortalama Na değerleri 131,13±3,96 mmol/L idi ve normonatremi grubuna göre anlamlı derecede düşüktü (138,73±2,27). Hiponatremik hastalarda diabetes mellitus (n:23, %44) konjestif kalp yetmezliği (n:9, %17) oranları daha yüksekti. Ameliyat öncesi ve toplam hastanede yatış süresi sırasıyla 5,21±2,68 ve 9,92±4,49 gündü ve hiponatremili hastalarda anlamlı olarak daha yüksekti. Hastane içi ve 1 yıllık mortalite oranları gruplar arasında benzerdi.
Sonuç: Kalça kırığı olan hastalarda hiponatremi insidansı %20,5 olarak saptandı ve bu hastalarda hem ameliyat öncesi hem de toplam hastanede kalış süresi uzadı. Bu çalışmada mortalite oranları benzer olsa da, hastanede kalış süresinin mortaliteyi arttırdığı bilindiğinden hiponatremi bu hastalarda dikkatli takip ve erken tedavi gerektirmektedir
References
- Warren AM, Grossmann M, Christ-Crain M, Russell N. Syndrome of inappropriate antidiuresis: from pathophysiology to management. Endocr Rev. 2023:28:bnad010.
- Shi LT, Cao XY, Gu R, Zhao JX, Zhang Y. Incidence and clinical significance of abnormalities in potassium, sodium and calcium levels in elderly patients with hip fractures during the perioperative period. Ann Ital Chir 2020;91:187-91.
- Martin-Grace J, Tomkins M, O'Reilly MW, Thompson CJ, Sherlock M. Approach to the patient: hyponatremia and the syndrome of inappropriate antidiuresis (SIAD). J Clin Endocrinol Metab. 2022;107:2362-76.
- Schiara LAM, Moirano G, Grosso E, Richiardi L, Tibaldi M, Spertino E et al. Hyponatremia, hypokalemia, and fragility fractures in old patients: more than an association? Calcif Tissue Int 2020;106:599-607.
- Kruse C, Eiken P, Verbalis J, Vestergaard P. The effect of chronic mild hyponatremia on bone mineral loss evaluated by retrospective national Danish patient data. Bone 2016;84:9-14.
- Gankam Kengne F, Andres C, Sattar L, Melot C, Decaux G. Mild hyponatremia and risk of fracture in the ambulatory elderly. QJM 2008;101:583-38.
- Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med. 2006;119:71.e1-e8.
- Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA et al. Hyponatremia-induced osteoporosis. J Bone Miner Res 2010;25:554-63.
- Hoorn EJ, Rivadeneira F, van Meurs JBJ, et al: Mild hyponatremia as a risk factor for fractures: the Rotterdam Study. J Bone Miner Res 2011;26:1822-8.
- Ayus JC, Bellido T, Negri AL. Hyponatremia and fractures: should hyponatremia be further studied as a potential biochemical risk factor to be included in FRAX algorithms? Osteoporos Int 2017;28:1543-8.
- Adrogué HJ, Tucker BM, Madias NE. Diagnosis and management of hyponatremia: a review. JAMA 2022;328:280-91.
- Ayus JC, Fuentes N, Go AS, Achinger SG, Moritz ML, Nigwekar SU et al. Chronicity of uncorrected hyponatremia and clinical outcomes in older patients undergoing hip fracture repair. Front Med (Lausanne) 2020;7:263.
- Clayton JA, Le Jeune IR, Hall IP. Severe hyponatraemia in medical in-patients: aetiology, assessment and outcome. QJM 2006;99:505-11.
- Horvath B, Kloesel B, Todd MM, Cole DJ, Prielipp RC. The evolution, current value, and future of the American Society of Anesthesiologists physical status classification system. Anesthesiology. 2021;135:904-19.
- Rocha AFB, Sá MVBO, Elihimas Junior UF. Hyponatremia in elderly patients with fragility fractures of the proximal femur: a cross-sectional study. J Bras Nefrol 2019;41:518-25.
- Nigwekar SU, Negri AL, Bajpai D, Allegretti A, Kalim S, Seethapathy H et al. Chronic prolonged hyponatremia and risk of hip fracture in elderly patients with chronic kidney disease. Bone 2019;127:556-62.
- Decaux G. Morbidity associated with chronic hyponatremia. J Clin Med. 2023;12:978.
- Rittenhouse KJ, To T, Rogers A, Wu D, Horst M, Edavettal M et al. Hyponatremia as a fall predictor in a geriatric trauma population. Injury 2015;46:119-23.
- Kruse C, Eiken P, Verbalis J, Vestergaard P. The effect of chronic mild hyponatremia on bone mineral loss evaluated by retrospective national Danish patient data. Bone 2016;84:9-14.
- Aqil A, Hossain F, Sheikh H, Aderinto J, Whitwell G, Kapoor H. Achieving hip fracture surgery within 36 hours: an investigation of risk factors to surgical delay and recommendations for practice. J Orthop Traumatol. 2016;17:207-13.
- Madsen CM, Jantzen C, Lauritzen JB, Abrahamsen B, Jorgensen HL. Hyponatremia and hypernatremia are associated with increased 30-day mortality in hip fracture patients. Osteoporos Int 2016;27:397-404.
- Tinning CG, Cochrane LA, Singer BR. Analysis of hyponatraemia associated post-operative mortality in 3897 hip fracture patients. Injury 2015;46:1328-32.
- Hagino T, Ochiai S, Watanabe Y, Senga S, Saito M, Takayama Y et al. Hyponatremia at admission is associated with in-hospital death in patients with hip fracture. Arch Orthop Trauma Surg 2013;133:507-11.
- Paruk F, Matthews G, Gregson CL, Cassim B. Hip fractures in South Africa: mortality outcomes over 12 months post-fracture. Arch Osteoporos 2020;15:76.
The incidence of hyponatremia in hospitalized patients due to hip fracture and its effect on mortality
Abstract
Purpose: Hyponatremia is associated with high morbidity and mortality in elderly patients. This study aimed to investigate the incidence of hyponatremia and its effects on the duration of hospitalization, in-hospital and 1-year mortality in elderly patients admitted to the hospital due to hip fracture.
Materials and Methods: After the approval of the ethics committee, patients over the age 65 and had hip surgery between January-December 2020 were retrospectively analyzed. The age, gender, fracture type, current comorbidities, and American Society of Anesthesiology physical status scores of the patients were recorded. Plasma Na, K, and Ca values in admission to hospital were recorded. Patients with hyponatremia and normonatremia were compared in terms of demographic data, comorbidities, duration of hospitalization, in-hospital, and 1-year mortality rates.
Results: Of the total 253 patients, 52(%20.5) had hyponatremia at hospital admission. Demographic data were similar in hyponatremic and normonatremic patients. In hyponatremia group mean Na values were 131.13±3.96 mmol/L and significantly lower than normonatremia group (138.73±2.27). In the hyponatremic group, diabetes mellitus was observed in 23 (44%) patients, and congestive heart failure was observed in 9 (17%) patients, which was higher than the normonatremic group. The preoperative and total duration of hospitalization was 5.21±2.68 and 9.92±4.49 days respectively and higher in patients with hyponatremia. In-hospital and 1-year mortality rates were similar between the groups.
Conclusion: The incidence of hyponatremia was found to be 20.5% in patients with hip fractures, and both the preoperative and total hospital stays were prolonged in these patients. Although mortality rates were similar in this study, hyponatremia requires careful follow-up and early treatment in these patients, since it is known that the length of hospital stay increases mortality.
References
- Warren AM, Grossmann M, Christ-Crain M, Russell N. Syndrome of inappropriate antidiuresis: from pathophysiology to management. Endocr Rev. 2023:28:bnad010.
- Shi LT, Cao XY, Gu R, Zhao JX, Zhang Y. Incidence and clinical significance of abnormalities in potassium, sodium and calcium levels in elderly patients with hip fractures during the perioperative period. Ann Ital Chir 2020;91:187-91.
- Martin-Grace J, Tomkins M, O'Reilly MW, Thompson CJ, Sherlock M. Approach to the patient: hyponatremia and the syndrome of inappropriate antidiuresis (SIAD). J Clin Endocrinol Metab. 2022;107:2362-76.
- Schiara LAM, Moirano G, Grosso E, Richiardi L, Tibaldi M, Spertino E et al. Hyponatremia, hypokalemia, and fragility fractures in old patients: more than an association? Calcif Tissue Int 2020;106:599-607.
- Kruse C, Eiken P, Verbalis J, Vestergaard P. The effect of chronic mild hyponatremia on bone mineral loss evaluated by retrospective national Danish patient data. Bone 2016;84:9-14.
- Gankam Kengne F, Andres C, Sattar L, Melot C, Decaux G. Mild hyponatremia and risk of fracture in the ambulatory elderly. QJM 2008;101:583-38.
- Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med. 2006;119:71.e1-e8.
- Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA et al. Hyponatremia-induced osteoporosis. J Bone Miner Res 2010;25:554-63.
- Hoorn EJ, Rivadeneira F, van Meurs JBJ, et al: Mild hyponatremia as a risk factor for fractures: the Rotterdam Study. J Bone Miner Res 2011;26:1822-8.
- Ayus JC, Bellido T, Negri AL. Hyponatremia and fractures: should hyponatremia be further studied as a potential biochemical risk factor to be included in FRAX algorithms? Osteoporos Int 2017;28:1543-8.
- Adrogué HJ, Tucker BM, Madias NE. Diagnosis and management of hyponatremia: a review. JAMA 2022;328:280-91.
- Ayus JC, Fuentes N, Go AS, Achinger SG, Moritz ML, Nigwekar SU et al. Chronicity of uncorrected hyponatremia and clinical outcomes in older patients undergoing hip fracture repair. Front Med (Lausanne) 2020;7:263.
- Clayton JA, Le Jeune IR, Hall IP. Severe hyponatraemia in medical in-patients: aetiology, assessment and outcome. QJM 2006;99:505-11.
- Horvath B, Kloesel B, Todd MM, Cole DJ, Prielipp RC. The evolution, current value, and future of the American Society of Anesthesiologists physical status classification system. Anesthesiology. 2021;135:904-19.
- Rocha AFB, Sá MVBO, Elihimas Junior UF. Hyponatremia in elderly patients with fragility fractures of the proximal femur: a cross-sectional study. J Bras Nefrol 2019;41:518-25.
- Nigwekar SU, Negri AL, Bajpai D, Allegretti A, Kalim S, Seethapathy H et al. Chronic prolonged hyponatremia and risk of hip fracture in elderly patients with chronic kidney disease. Bone 2019;127:556-62.
- Decaux G. Morbidity associated with chronic hyponatremia. J Clin Med. 2023;12:978.
- Rittenhouse KJ, To T, Rogers A, Wu D, Horst M, Edavettal M et al. Hyponatremia as a fall predictor in a geriatric trauma population. Injury 2015;46:119-23.
- Kruse C, Eiken P, Verbalis J, Vestergaard P. The effect of chronic mild hyponatremia on bone mineral loss evaluated by retrospective national Danish patient data. Bone 2016;84:9-14.
- Aqil A, Hossain F, Sheikh H, Aderinto J, Whitwell G, Kapoor H. Achieving hip fracture surgery within 36 hours: an investigation of risk factors to surgical delay and recommendations for practice. J Orthop Traumatol. 2016;17:207-13.
- Madsen CM, Jantzen C, Lauritzen JB, Abrahamsen B, Jorgensen HL. Hyponatremia and hypernatremia are associated with increased 30-day mortality in hip fracture patients. Osteoporos Int 2016;27:397-404.
- Tinning CG, Cochrane LA, Singer BR. Analysis of hyponatraemia associated post-operative mortality in 3897 hip fracture patients. Injury 2015;46:1328-32.
- Hagino T, Ochiai S, Watanabe Y, Senga S, Saito M, Takayama Y et al. Hyponatremia at admission is associated with in-hospital death in patients with hip fracture. Arch Orthop Trauma Surg 2013;133:507-11.
- Paruk F, Matthews G, Gregson CL, Cassim B. Hip fractures in South Africa: mortality outcomes over 12 months post-fracture. Arch Osteoporos 2020;15:76.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research |
| Authors | |
| Early Pub Date | July 11, 2023 |
| Publication Date | July 2, 2023 |
| Acceptance Date | June 4, 2023 |
| Published in Issue | Year 2023 Volume: 48 Issue: 2 |
