Meta-analysis of factors affecting hyponatremia after spinal cord injury

To systematically evaluate the risk factors for hyponatremia in patients with spinal cord injury (SCI) through a meta-analysis, and to provide evidence-based guidance for early identification of high-risk populations and the development of preventive strategies in clinical practice.

Electronic databases including China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, Chinese Biomedical Literature Database (CBM), PubMed, and Web of Science were searched from their inception to November 10, 2024. Literature screening, data extraction, and quality assessment were independently conducted by two researchers. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of the included studies. Meta-analysis was performed using RevMan 5.3 software.

A total of 14 studies involving 2,729 patients with SCI were included, among whom 1,160 patients developed hyponatremia and 1,569 had normal serum sodium levels. The NOS scores of the included studies ranged from 7 to 8, indicating generally high methodological quality. Meta-analysis results showed that high-level spinal cord injury (OR = 1.71, 95% CI: 1.04-2.81), complete spinal cord injury (OR = 4.96, 95% CI: 3.75-6.57), concomitant traumatic brain injury (OR = 2.70, 95% CI: 1.79-4.07), and the use of assisted ventilation (OR = 3.28, 95% CI: 1.52-7.09) were significant risk factors for hyponatremia in patients with SCI (p < 0.05). A funnel plot based on complete spinal cord injury was not completely symmetrical, suggesting a potential risk of publication bias.

Current evidence indicates that high-level spinal cord injury (≤C4), complete spinal cord injury, concomitant craniocerebral injury, and the use of assisted ventilation are significant risk factors for hyponatremia in patients with SCI. Enhanced monitoring and management of these high-risk populations are recommended to facilitate early identification and timely intervention for hyponatremia.

The systematic review was registered in PROSPERO (Unique Identifier: CRDCRD42024585004).