A predictive value of hyponatremia for poor outcome and cerebral infarction in high-grade aneurysmal subarachnoid haemorrhage patients

Zheng, Bingjie; Qiu, Yan; Jin, Haiyan; Wang, L; X, Chen; Shi, Changbin; Zhao, Shen

doi:10.1136/jnnp.2009.180349

Cited by 48 publications

(26 citation statements)

References 31 publications

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“…Observing predictive correlations between hyponatremia and poor outcome, we have found a certain connection which conflicts with the results of Qureshi et al and Zheng et al (17) This study has less statistical power than leading studies which we compared, but the results are still very interesting and imply a possible use of hyponatremia as an additional predictor of developing clinical deterioration due to DCI.…”

Section: Discussioncontrasting

confidence: 56%

“…The predictive value of hyponatremia on clinical outcome and correlations between DCI and hyponatremia was a subject of some studies but the results were inconsistent (2,3,(15)(16)(17). These results did not confirm or negate a possible connection, and our study is an attempt to provide a new contribution in resolving this potentially very interesting matter.…”

Section: Introductionmentioning

confidence: 63%

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Clinical and Predictive Significance of Hyponatremia After Aneurysmal Subarachnoid Hemorrhage

Vrsajkov¹,

Javanović²,

Stanisavljević³

et al. 2012

Balkan Med J

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Objective: Hyponatremia after SAH was the object of several studies with conflicting results. The aim of this study was to determine a predictive correlation of hyponatremia with delayed cerebral ischemia (DCI) and poor clinical outcome. Material and Methods:We have used a retrospective hospital chart review of 82 patients with SAH treated from August 2008 to August 2010. Patients were divided into hyponatremia and normonatremia groups. Hyponatremia was defined as serum sodium level <135 mmol/l. Information compared and analyzed included demographics, preoperative neurological status, aneurysm characteristics, postoperative intensive care, duration of stay, DCI and clinical outcome at hospital discharge. P<0.05 was considered significant.Results: Thirty-two patients with SAH (39%) developed hyponatremia. In that group we had a significantly higher WFNS score at admission (p=0.03) and longer duration of stay in intensive care (p=0.001). DCI with transit or definitive deficit included 20 patients (62%) in the hyponatremia group, and 19 patients (38%) in the normonatremia group (p=0.03). Binary enter logistic regression revealed a significant correlation of hyponatremia with DCI (p=0.03) and poor clinical outcome (p=0.001). Conclusion:This result revealed a possible use of hyponatremia as an additional predictor of developing DCI and poor clinical outcome.

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Section: Discussioncontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 63%

Clinical and Predictive Significance of Hyponatremia After Aneurysmal Subarachnoid Hemorrhage

Vrsajkov¹,

Javanović²,

Stanisavljević³

et al. 2012

Balkan Med J

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“…In patients with aneurysmal subarachnoid hemorrhage (aSAH), hyponatremia is associated with reversible neurological deterioration, an increased risk of brain ischemia and vasospasm, cerebral edema and mass effect, seizures, and death [8]. However, hyponatremia did not predict poor outcome in all-grade aSAH patients in another study [9]. …”

Section: Introductionmentioning

confidence: 99%

Association of Hyponatremia in Acute Stroke Stage with Three-Year Mortality in Patients with First-Ever Ischemic Stroke

et al. 2012

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Background: Hyponatremia is the most common electrolyte disorder in hospitalized patients, and is frequently a marker of a significant underlying disease. The prognostic value of hyponatremia in patients with acute first-ever ischemic stroke is not known. We aimed to analyze whether hyponatremia in the acute stroke stage contributed to the risk of mortality or recurrent stroke in these patients. Methods: We studied 925 patients presenting with acute first-ever ischemic stroke between 2002 and 2004. Sodium levels were obtained on arrival at the emergency room within 3 days of acute stroke onset. Hyponatremia was defined as a serum sodium concentration of 134 mmol/l or less. Clinical presentation, stroke risk factors, associated medical disease, and outcome were recorded. All patients were followed for 3 years for survival analysis. A multivariate Cox proportional hazards model was used to identify risk factors for 3-year mortality in these patients. We also constructed Kaplan-Meier survival curves, and compared groups with hyponatremia and normonatremia by means of log rank tests for significant differences. Results: Among the patients with acute first-ever ischemic stroke, 107 (11.6%) were hyponatremic. Among stroke risk factors, the prevalence of diabetes mellitus was significantly higher among hyponatremic patients (p < 0.001). Prevalence of chronic renal insufficiency was also higher in the hyponatremic group (p = 0.002). Clinical presentations, such as the length of acute ward stay, initial impaired consciousness, and clinical course in acute stroke were similar among normo- and hyponatremic patients. Among the complications, pneumonia and urinary tract infection were significantly higher in hyponatremic than in normonatremic patients. After multivariate logistic regression analysis, diabetes mellitus and chronic renal insufficiency were associated with hyponatremia in these patients. Kaplan-Meier analysis indicated that the survival rate was significantly lower in hyponatremic patients than in normonatremic patients (log rank test; p value <0.001). After multivariate Cox proportional hazards model analysis, hyponatremia was a significant predictor of 3-year mortality in these patients after adjustment for related variables (p value = 0.003, hazard ratio = 2.23, 95% confidence interval: 1.30–3.82). Conclusion: Hyponatremia in the acute stroke stage is a predictor of 3-year mortality in patients with acute first-ever ischemic stroke that is independent of other clinical predictors of adverse outcome.

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“…Hyponatremia is common in the setting of central nervous system disease and is associated with significant morbidity and mortality rates [6]. One third of patients in the acute phase of subarachnoid haemorrhage and more than one third of neurosurgical patients especially following transsphenoidal surgery suffer from this electrolyte disorder [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…One third of patients in the acute phase of subarachnoid haemorrhage and more than one third of neurosurgical patients especially following transsphenoidal surgery suffer from this electrolyte disorder [6,7]. It is often attributed to SIADH.…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia during a Severe Pneumococcal Meningitis with Renal Salt Wasting: A Cerebral Salt Wasting Syndrome?

Delabre¹,

Pommet²,

Amigues³

et al. 2011

OJNeph

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Background: The existence and prevalence of cerebral salt wasting and its differentiation from syndrome of inappropriate antidiuretic hormone have been controversial. This controversy stems from overlapping clinical and laboratory findings and an inability to assess the volume status of these patients. Objectives:To present a case of a cerebral salt wasting syndrome secondary to a bacterial mengitis and to emphasize the difficulty to assess the diagnosis. Case report: A 51-year-old male admitted to the ICU for a severe bacterial meningitis who developed, four days later, hyponatremia associated with hypovolemia due to a renal salt wasting. Clinical and biological parameters were collected; electrolytes balances and salt clearances were calculated to best investigate this hydroelectrolytic disorder. Patient's volume status and improvement after fluid and sodium replacement highly suggests the diagnosis of a cerebral salt wasting syndrome. Conclusion: A thorough analysis of this case showed that occurrence of hyponatremia and renal salt wasting after brain agression is not univocal underlying the fact that the diagnosis of cerebral salt wasting should be assessed only after a careful examination of the different determinants of the hydroelectrolytical balance.

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A predictive value of hyponatremia for poor outcome and cerebral infarction in high-grade aneurysmal subarachnoid haemorrhage patients

Abstract: Hyponatremia does not predict poor outcome in all-grade aSAH patients. However, late-onset hyponatremia in high-grade aSAH patients is associated with cerebral infarction. Therefore, the appropriate management of hyponatremia could be beneficial in those patients.

Cited by 48 publications

References 31 publications

Clinical and Predictive Significance of Hyponatremia After Aneurysmal Subarachnoid Hemorrhage

Clinical and Predictive Significance of Hyponatremia After Aneurysmal Subarachnoid Hemorrhage

Association of Hyponatremia in Acute Stroke Stage with Three-Year Mortality in Patients with First-Ever Ischemic Stroke

Hyponatremia during a Severe Pneumococcal Meningitis with Renal Salt Wasting: A Cerebral Salt Wasting Syndrome?

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