TY - JOUR
T1 - Sodium and Its Impact on Outcome After Aneurysmal Subarachnoid Hemorrhage in Patients With and Without Delayed Cerebral Ischemia
AU - Labib, Homeyra
AU - Tjerkstra, Maud A
AU - Coert, Bert A
AU - Post, René
AU - Vandertop, W Peter
AU - Verbaan, Dagmar
AU - Müller, Marcella C A
N1 - Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
PY - 2024/1/11
Y1 - 2024/1/11
N2 - OBJECTIVES: To perform a detailed examination of sodium levels, hyponatremia and sodium fluctuations, and their association with delayed cerebral ischemia (DCI) and poor outcome after aneurysmal subarachnoid hemorrhage (aSAH).DESIGN: An observational cohort study from a prospective SAH Registry.SETTING: Tertiary referral center focused on SAH treatment in the Amsterdam metropolitan area.PATIENTS: A total of 964 adult patients with confirmed aSAH were included between 2011 and 2021.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: A total of 277 (29%) developed DCI. Hyponatremia occurred significantly more often in DCI patients compared with no-DCI patients (77% vs. 48%). Sodium levels, hyponatremia, hypernatremia, and sodium fluctuations did not predict DCI. However, higher sodium levels were significantly associated with poor outcome in DCI patients (DCI onset -7, DCI +0, +1, +2, +4, +5, +8, +9 d), and in no-DCI patients (postbleed day 6-10 and 12-14). Also, hypernatremia and greater sodium fluctuations were significantly associated with poor outcome in both DCI and no-DCI patients.CONCLUSIONS: Sodium levels, hyponatremia, and sodium fluctuations were not associated with the occurrence of DCI. However, higher sodium levels, hypernatremia, and greater sodium fluctuations were associated with poor outcome after aSAH irrespective of the presence of DCI. Therefore, sodium levels, even with mild changes in levels, warrant close attention.
AB - OBJECTIVES: To perform a detailed examination of sodium levels, hyponatremia and sodium fluctuations, and their association with delayed cerebral ischemia (DCI) and poor outcome after aneurysmal subarachnoid hemorrhage (aSAH).DESIGN: An observational cohort study from a prospective SAH Registry.SETTING: Tertiary referral center focused on SAH treatment in the Amsterdam metropolitan area.PATIENTS: A total of 964 adult patients with confirmed aSAH were included between 2011 and 2021.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: A total of 277 (29%) developed DCI. Hyponatremia occurred significantly more often in DCI patients compared with no-DCI patients (77% vs. 48%). Sodium levels, hyponatremia, hypernatremia, and sodium fluctuations did not predict DCI. However, higher sodium levels were significantly associated with poor outcome in DCI patients (DCI onset -7, DCI +0, +1, +2, +4, +5, +8, +9 d), and in no-DCI patients (postbleed day 6-10 and 12-14). Also, hypernatremia and greater sodium fluctuations were significantly associated with poor outcome in both DCI and no-DCI patients.CONCLUSIONS: Sodium levels, hyponatremia, and sodium fluctuations were not associated with the occurrence of DCI. However, higher sodium levels, hypernatremia, and greater sodium fluctuations were associated with poor outcome after aSAH irrespective of the presence of DCI. Therefore, sodium levels, even with mild changes in levels, warrant close attention.
KW - aneurismal subarachnoid hemorrhage
KW - cerebral ischemia
KW - critical care
KW - prognosis
KW - sodium
KW - stroke
KW - subarachnoid hemorrhage
UR - http://www.scopus.com/inward/record.url?scp=85190720911&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/CCM.0000000000006182
DO - https://doi.org/10.1097/CCM.0000000000006182
M3 - Article
C2 - 38206089
SN - 0090-3493
VL - 52
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 5
ER -