Journal of pediatric surgery · 2025
Beyond hyponatremia: The crucial role of hypernatremia and hypokalemia in pediatric intussusception surgical outcomes.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Chang Chih-Yang, Chen Solomon Chih-Cheng, Kuo Hsin-Ching, Huo Chia-Hsin, Tsai Ching-Fang, Yang Hsin-Yi
Аннотация
BACKGROUND: While hyponatremia is a recognized marker of disease severity in certain pediatric gastrointestinal conditions, the prognostic value of serum potassium and a comprehensive assessment of electrolyte imbalances in intussusception outcomes remain limited. We aimed to quantify the association between dysnatremia and dyskalemia at presentation and major surgical complications in children with intussusception.
METHODS: This retrospective, multicenter cohort study utilized de-identified data from the TriNetX Global Research Network, covering over 150 healthcare organizations. We included 11,111 pediatric patients (≤18 years) with intussusception who had baseline serum sodium and potassium levels documented within one day of diagnosis. We evaluated a gradient of surgical outcomes-open reduction (C1), bowel perforation or resection (C2), and peritonitis or sepsis (C3)-using Cox proportional hazards models, adjusting for age group (0-3 vs. 3-18 years) and sex.
RESULTS: Electrolyte disturbances were prevalent: hyponatremia (9.3 %), hypernatremia (1.8 %), hypokalemia (4.7 %), and hyperkalemia (2.8 %). Surgical complication rates were significantly higher in abnormal groups (e.g., 6.2 % for normonatremia vs. 42.2 % for hypernatremia). After adjustment, hypernatremia demonstrated the most potent association across all outcomes, especially with C3 (aHR 7.89; 95 % CI: 4.41-14.10) and C2 (aHR 6.65; 95 % CI: 3.82-11.58). Hypokalemia was also strongly and independently associated with C3 (aHR 4.20) and C2 (aHR 2.69). Hyponatremia was independently associated with all three surgical outcomes with more modest effect sizes.
CONCLUSIONS: Electrolyte abnormalities, particularly hypernatremia and hypokalemia, are crucial and objective early indicators of surgical risk in pediatric intussusception. Routine assessment of serum sodium and potassium at presentation can support timely triage and inform operative decision-making.
METHODS: This retrospective, multicenter cohort study utilized de-identified data from the TriNetX Global Research Network, covering over 150 healthcare organizations. We included 11,111 pediatric patients (≤18 years) with intussusception who had baseline serum sodium and potassium levels documented within one day of diagnosis. We evaluated a gradient of surgical outcomes-open reduction (C1), bowel perforation or resection (C2), and peritonitis or sepsis (C3)-using Cox proportional hazards models, adjusting for age group (0-3 vs. 3-18 years) and sex.
RESULTS: Electrolyte disturbances were prevalent: hyponatremia (9.3 %), hypernatremia (1.8 %), hypokalemia (4.7 %), and hyperkalemia (2.8 %). Surgical complication rates were significantly higher in abnormal groups (e.g., 6.2 % for normonatremia vs. 42.2 % for hypernatremia). After adjustment, hypernatremia demonstrated the most potent association across all outcomes, especially with C3 (aHR 7.89; 95 % CI: 4.41-14.10) and C2 (aHR 6.65; 95 % CI: 3.82-11.58). Hypokalemia was also strongly and independently associated with C3 (aHR 4.20) and C2 (aHR 2.69). Hyponatremia was independently associated with all three surgical outcomes with more modest effect sizes.
CONCLUSIONS: Electrolyte abnormalities, particularly hypernatremia and hypokalemia, are crucial and objective early indicators of surgical risk in pediatric intussusception. Routine assessment of serum sodium and potassium at presentation can support timely triage and inform operative decision-making.