Systematic review and meta-analysis links injury severity and infection to hyponatremia in acute spinal cord injury patients
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Key Takeaway
Note that upper cervical injury, complete SCI, hypoproteinemia, and infection are associated with hyponatremia in acute spinal cord injury.
This systematic review and meta-analysis examined the association between various clinical factors and hyponatremia in a population of 2,355 patients with acute spinal cord injury. The study synthesized data to identify specific risk factors linked to electrolyte disturbances in this vulnerable group.
The analysis reported that upper cervical spine injury was associated with hyponatremia, with an odds ratio of 6.05 and a 95%CI of 2.79, 13.10. Complete spinal cord injury also showed a positive association, with an odds ratio of 5.35 and a 95%CI of 3.15, 9.07. Additionally, hypoproteinemia was associated with hyponatremia, yielding an odds ratio of 2.96 and a 95%CI of 1.10, 7.92.
Infection was identified as another significant factor, associated with hyponatremia with an odds ratio of 2.20 and a 95%CI of 1.67, 2.90. The authors note that adverse events, serious adverse events, discontinuations, and tolerability were not reported. The review does not establish causality but highlights the need for targeted monitoring and intervention of high-risk patients to reduce the incidence of hyponatremia and improve clinical outcomes.
View Original Abstract ↓
BackgroundHyponatremia is a prevalent electrolyte disorder in patients with acute spinal cord injury (SCI), which can significantly increase the risk of adverse complications and impair long-term prognosis. Despite its clinical significance, the existing evidence on the factors associated with hyponatremia in this patient population remains fragmented and inconsistent, leading to uncertainties in clinical prevention and management.MethodsSystematic searches were conducted in PubMed, Embase, Web of Science, Cochrane Library, and Chinese databases including CNKI, Wan fang, and VIP, retrieving relevant studies from the inception of each database up to December 20, 2025. Included observational studies reporting factors associated with hyponatremia in patients with acute spinal cord injury. Two researchers independently performed literature screening, data extraction, and quality assessment. Results were synthesized using a random-effects model to calculate odds ratios (OR) with 95% confidence intervals (CI), with assessments of heterogeneity, publication bias, and sensitivity analyses.ResultsTwelve eligible studies involving 2,355 patients were included in the meta-analysis. The results indicate an association between upper cervical spine injury [OR = 6.05, 95%CI (2.79, 13.10)], complete SCI [OR = 5.35, 95%CI (3.15, 9.07)], hypoproteinemia [OR = 2.96, 95%CI (1.10, 7.92)], infection [OR = 2.20, 95%CI (1.67, 2.90)], and hyponatremia in patients with SCI.ConclusionThis meta-analysis demonstrates that hyponatremia in patients with acute SCI is closely related to the level and severity of spinal cord injury, with upper cervical spine injury and complete SCI being potential major risk indicators. Additionally, hypoproteinemia and infection are important associated factors. These findings highlight the need for targeted monitoring and intervention of high-risk patients to reduce the incidence of hyponatremia and improve clinical outcomes.
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