What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute spinal cord injury (n=2355). Intervention: Upper cervical spine injury vs. Without upper cervical spine injury. Primary outcome: Hyponatremia (OR 6.05, 95% CI 2.79, 13.10).

What question did this study set out to answer?

This study aims to identify and synthesize factors associated with hyponatremia in patients with acute spinal cord injury.

May 9, 2026Open Access

Factors associated with hyponatremia in patients with acute spinal cord injury: a systematic review and meta-analysis

Key Result

Upper cervical spine injury was significantly associated with an increased risk of hyponatremia in patients with acute spinal cord injury (OR 6.05).

Key Points

This study aims to identify and synthesize factors associated with hyponatremia in patients with acute spinal cord injury.
Conducted systematic searches in multiple databases including PubMed and Embase.
Included observational studies reporting factors associated with hyponatremia in acute spinal cord injury patients.
Used a random-effects model to calculate odds ratios and assess publication bias.
Identified an association between upper cervical spine injury (OR = 6.05, 95%CI 2.79-13.10) and hyponatremia.
Complete spinal cord injury linked to higher risk (OR = 5.35, 95%CI 3.15-9.07).
Hypoproteinemia (OR = 2.96, 95%CI 1.10-7.92) and infection (OR = 2.20, 95%CI 1.67-2.90) also significantly increased risk.

Study Design

Type

Meta-Analysis (n=2,355)

Structured PICO

Population

2,355 patients with acute spinal cord injury from 12 observational studies

Outcome

Factors associated with hyponatremiasurrogate

Upper cervical spine injury, complete SCI, hypoproteinemia, and infection are major risk factors for hyponatremia in patients with acute spinal cord injury.

Main Result

Effect estimate: OR 6.05 (95% CI 2.79, 13.10)

Limitations

All included studies were observational, limiting causal inference.
Substantial heterogeneity was present in several analyses.
Small number of studies available for some variables reduced statistical power.
Adjustment strategies used across studies were not uniform.
Most included studies were from China, limiting external validity.
Possible collinearity between injury level and injury severity could not be fully assessed.

Abstract

Background Hyponatremia 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. Methods Systematic 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. Results Twelve 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. Conclusion This 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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