Dysnatremia and 6-Month Functional Outcomes in Critically Ill Patients With Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study.

Abstract

OBJECTIVES:

To investigate the association between plasma sodium concentrations and 6-month neurologic outcome in critically ill patients with aneurysmal subarachnoid hemorrhage.

DESIGN:

Prospective cohort study.

SETTING:

Eleven ICUs in Australia and New Zealand.

PARTICIPANTS:

Three-hundred fifty-six aneurysmal subarachnoid hemorrhage patients admitted to ICU between March 2016 and June 2018. The exposure variable was daily measured plasma sodium.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Six-month neurologic outcome as measured by the modified Rankin Scale. A poor outcome was defined as a modified Rankin Scale greater than or equal to 4. The mean age was 57 years (± 12.6 yr), 68% were female, and 32% (n = 113) had a poor outcome. In multivariable analysis, including age, illness severity, and process of care measures as covariates, higher mean sodium concentrations (odds ratio, 1.17; 95% CI, 1.05-1.29), and greater overall variability-as measured by the sd (odds ratio, 1.53; 95% CI, 1.17-1.99)-were associated with a greater likelihood of a poor outcome. Multivariable generalized additive modeling demonstrated, specifically, that a high initial sodium concentration, followed by a gradual decline from day 3 onwards, was also associated with a poor outcome. Finally, greater variability in sodium concentrations was associated with a longer ICU and hospital length of stay: mean ICU length of stay ratio (1.13; 95% CI, 1.07-1.20) and mean hospital length of stay ratio (1.08; 95% CI, 1.01-1.15).

CONCLUSIONS:

In critically ill aneurysmal subarachnoid hemorrhage patients, higher mean sodium concentrations and greater variability were associated with worse neurologic outcomes at 6 months, despite adjustment for known confounders. Interventional studies would be required to demonstrate a causal relationship.

• Authors: Jeremy Cohen, Anthony Delaney, James Anstey, Matthew Anstey, Deborah Barge, Rinaldo Bellomo, Vishnu Bhardwa, Gail Brinkerhoff, Jasmin Board, Anna Campain, D James Cooper, Gian Luca Di Tanna, Mark Finnis, Emily Fitzgerald, Oliver Flower, Paul Healey, Anna Hunt, Cassie Lawrence, Jan Merthens, Lynette Newby, David Pearson, Eamon Raith, Yvonne Robertson, Sacha Schweikert, Therese Starr, Mandy Tallott, Andrew van der Poll, Paul Young, Andrew Udy
• Journal: Critical care explorations (Crit Care Explor) Vol. 3 Issue 6 Pg. e0445 (Jun 2021) ISSN: 2639-8028 [Electronic] United States
• PMID: 34124687 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.