Analysis On Clinical Data Of Patients With Syndrome Of Inappropriate Secretion Of Antidiuretic Hormone And Cerebral Salt Wasting Syndrome

Objectives:To investigate a fast and convenient method to identify syndrome of inappropriate secretion of antidiuretic hormone(SIADH)and cerebral salt wasting syndrome(CSWS),which may provide guidance for early warnings and prevention of intractable hyponatremia.Methods:A retrospective study of 129 patients with SIADH and CSWS was performed at the First Hospital of Jilin University,between January 1,2015 and December 31,2017.The general data such as sex,age,past medical history,praxiology,and length of stay as well as dynamic changes of parameters before and after treatment were analyzed retrospectively.All data were analyzed by SPSS 22.0 software and a value P < 0.05 was considered to be statistically significant.Results:1.General information(1)A total of 129 cases of CSWS and SIADH were diagnosed,including 43%CSWS and 57% SIADH.In paitents with neurological diseases complicated by hyponatremia,the number of patients with CSWS was significantly more than that of patients with SIADH(P < 0.005).The diagnostic rate of SIADH and CSWSincreased year by year from 2015 to 2017.(2)The causes of CSWS included subarachnoid hemorrhage(40%),stroke(25.4%),encephalitis(18.8%),postoperative pituitary tumor(10.9%),and spinal cord injuries(5.5%),while the the etiology of SIADH consisted of neurological diseases(43.2%),tumor(32.5%),lung diseases(14.6%),others(8.2%),and drugs(1.5%).(3)The average age was significantly higher in the CSWS group when compared with the SIADH group(P < 0.0001);(4)The number of male patients was significantly more than the number of female patients in CSWS group(P < 0.0001).(5)The number of patients with a history of alcohol use was significantly greater in the CSWS group when compared with the SIADH group(P = 0.0065).2.The comparison of clinical symptoms(1)The number of patients who complained of nausea,vomiting,and fatigue were significantly lower in the CSWS group when compared with the SIADH group(P < 0.05).(2)The proportion of consciousness disorders was significantly higher in the CSWS group when compared with the SIADH group(P < 0.001).(3)The average value of systolic blood pressure(SBP)was significantly lower in the CSWS group when compared with the SIADH group(P = 0.02).(4)The proportion of patients with lower-than-usual blood pressure was significantly higher in the CSWS group when compared with the SIADH group(P <0.001).(5)The heart rate was significantly higher in the CSWS group when compared with the SIADH group(P = 0.0036).3.The comparison of parameters associated with blood volume(1)The mean corpuscular hemoglobin concentration(MCHC)levels was significantly higher in the CSWS group when compared with the SIADH group(P =0.026);while,there was no significant difference in hematocrit,red blood cell count,and hemoglobin between the two groups(P > 0.05).(2)The levels of uric acid and blood urea nitrogen(BUN)were significantly higher in the CSWS group when compared with the SIADH(P < 0.05).(3)Paralleled with the improvement of hyponatremia,uric acid level was significantly lower after the treatment in the CSWS group(P < 0.001).While,uric acid level was significantly higher after the treatment in the SIADH group(P <0.001).(4)Paralleled with the improvment of hyponatremia,BUN levels in the CSWS group was significantly lower after the treatment(P < 0.001).There was no significant difference in BUN levels in the SIADH group befor and after the treatment(P > 0.05).(5)There was no significant difference in blood lipid,albumin,and CO2 combining power between the two groups(P > 0.05).4.The comparison of parameters associated with sodium balance(1)Blood sodium levels and plasma osmotic pressure were significantly higher in the CSWS group when compared with the SIADH group(P < 0.05);(2)Urine volume,urine sodium levels,and urine osmotic pressure were significantly higher in the CSWS group when compared with the SIADH group(P <0.001).(3)There was no significant difference in the levels of serum potassium and blood glucose between the two groups(P > 0.05).5.The comparision of hormone-related indicators(1)The mean value of brain natriuretic peptide(BNP)was significantly higher in the CSWS group when compared with the SIADH group(P = 0.009).(2)The mean value of FT4 was significantly lower in the CSWS group when compared with the SIADH group(P = 0.0169).(3)There was no significant difference in the levels of free T3(FT3),thyroid stimulating hormone(TSH),cortisol,and adrenocorticotropic hormone(ACTH)at 8a.m.between the two groups(P > 0.05).6.Multiple logistic regression analysis(1)The high level of SBP makes the diagnosis of hyponatremia patients more inclined to SIADH(P<0.001,OR=1.074,95%CI: 1.022-1.129);(2)The high levels of urine,BNP and 24 h sodium make the diagnosis of hyponatremia patients more inclined to CSWS(P <0.05,OR < 1).Conclusions:(1)In the hospitalized patients who suffered from refractory hyponatremia,the number of SIADH was more than the number of CSWS;while,when it complicated with neurological diseases,the number of CSWS was higher than that of SIADH.(2)The diagnostic rate of SIADH and CSWS has been increasing year by year in our hospital,suggesting increased understanding of the disease by medical practitioners.(3)A higher-than-usual blood pressure and high level of systolic blood pressure support the diagnosis of SIADH;whereas lower-than-usual blood pressure at diagnosis suggestive of CSWS.(4)The high levels of mean corpuscular hemoglobin concentration,uric acids,BUN,BNP,plasma osmotic pressure,urine volume,urine osmotic pressure,and elevated level of 24-h urinary sodium support the diagnosis of CSWS.(5)Dynamic monitoring of the uric acid level may contribute to the differentiatial diagnosis of SIADH and CSWS.Paralleled with the improvement of hyponatremia,elevated serum uric acids support the diagnosis of SIADH,while low serum uric acid level support the diagnosis of CSWS.