Chronische Hyponatriämie in Patienten mit proximalen Femurfrakturen nach Niedrigenergie Trauma: Eine retrospektive Studie in einem Level 1 Traumazentrum

Chronic hyponatremia in patients with proximal femoral fractures after low energy trauma: A retrospective study in a level-1 trauma center

by Christian Popescu
Doctoral thesis
Date of Examination:2020-03-04
Date of issue:2020-02-26
Advisor:Prof. Dr. Stephan Sehmisch
Referee:Prof. Dr. Dirk Raddatz
Referee:Prof. Dr. Margarete Schön
Persistent Address: http://dx.doi.org/10.53846/goediss-7862

 

 

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Abstract

English

In this study, we evaluated data from 314 patients with proximal femur fractures after low-energy trauma who were treated between 01/01/2010 and 31/12/2013 at the University Hospital Göttingen. In 15.6% of the patients, we found hyponatremia (serum sodium <135 mmol / l) on admission. In the age group of 18-45 year olds (n = 5) the share was 0%, in the group 46-60 year olds (n = 21) 28.6%, in the group 61-70 year olds (n = 49) at 14.3%, in the 71-80 year old group (n = 95) 16.8% and in the> 80 year old group (n = 144) 13.9%. The observed prevalence was comparable to observations from similar studies and was significantly higher than the prevalence in control groups without osteoporotic fractures from the literature and above the prevalence in a control group for high-energy trauma that we examined. The subgroups with hyponatraemia and without hyponatraemia were comparable in terms of average age, BMI and gender distribution. In the age groups of 71-80 year olds and over 80 year olds, however, women showed hyponatremia significantly more often than men (17.9% vs. 15.4% and 16.4% vs. 5.9%, respectively). Regarding the pre-medication, we found a significant correlation between the occurrence of hyponatremia and the intake of sartans (OR 3.21; 95% CI 1.388-7.114) and aldosterone antagonists (OR 2.97; 95% CI 0.993-7.98). We saw no significant association between the occurrence of hyponatremia and the intake of ACE inhibitors, PPIs, loop diuretics, SSRIs and thiazide diuretics. When comparing the medical preconditions, we found a significant correlation between the occurrence of hyponatremia and the presence of chronic alcohol abuse (OR 8.525; 95% CI 2.452-30.08). In addition, we observed a significant negative correlation between the occurrence of hyponatremia and the presence of diabetes mellitus and renal insufficiency, for which we do not suspect a causal relationship. We could not establish a statistically significant connection between the occurrence of hyponatremia and the presence of hypothyroidism or heart failure. In further studies, the correlations between medication and medical preconditions and the occurrence of hyponatremia should be checked for causality. Treating physicians should consider chronic hyponatraemia as an additional risk factor in risk patients for osteoporotic fractures and critically review medication that is associated with the occurrence of hyponatraemia and adjust it if necessary.
Keywords: Hyponatremia
 
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