Hyponatremia Is Associated With Post-thrombolysis Hemorrhagic Transformation and Poor Clinical Outcome in Ischemic Stroke Patients

Abstract

ObjectiveHyponatremia is the most common electrolyte disorder encountered in patients with neurological conditions, such as stroke. Studies have shown that it is associated with worse clinical outcomes and increased mortality in acute ischemic stroke (AIS). However, the role of hyponatremia has not been elucidated in patients with AIS who received intravenous thrombolysis (IVT) therapy. Therefore, this study aimed to investigate the effect of serum sodium levels on the clinical outcome and hemorrhagic transformation (HT) in patients with AIS who received thrombolytic therapy.MethodsPatients diagnosed with AIS who received IVT therapy between May 2015 and December 2020 were included in this study. All patients were screened for serum sodium levels immediately after hospital admission, before IVT therapy. The occurrence of HT was evaluated using computed tomography (CT) 24 ± 2 h after thrombolysis. Then, 3-month clinical outcomes were obtained by telephone calls or outpatient visits, and poor 3-month clinical outcomes were defined as modified Rankin Scale scores ≥3. The effects of serum sodium levels on the clinical outcome and HT were assessed using the multivariate logistic regression analysis.ResultsOf the 963 included patients, 82 (8.5%) had hyponatremia, 157 (16.3%) developed HT, and 333 (34.6%) had poor 3-month outcomes. Of the 82 patients with hyponatremia, 21 (25.6%) developed HT, and 39 (47.6%) had poor 3-month outcomes. Patients with hyponatremia had a higher incidence of post-thrombolysis HT (25.6 vs. 15.4%, p = 0.017) and worse clinical outcome (47.6 vs. 33.4%, p = 0.01) than those with normal serum sodium levels. Patients had significantly lower serum sodium levels in those with HT [138.4 (136.4–140.3, IQR) vs. 139.0 (137.2–140.7, IQR) mmol/L, p = 0.019] and poor 3 month outcome [139.0 (137.2–140.7) vs. 138.4 (136.7–140.3) mmol/L, p = 0.005] than those without. After adjusting for major covariates, the multivariate logistic regression analysis revealed that lower serum sodium levels were independently associated with an increased risk of HT [odds ratio (OR) = 1.804; 95% CI: 1.048–3.105] and poor 3-month outcome (OR = 1.647; 95% CI: 1.012–2.679).ConclusionLower serum sodium level was an independent risk factor for post-thrombolysis HT and poor clinical outcome in patients with AIS who received thrombolytic therapy.

Hyponatremia is associated with unfavorable outcomes after reperfusion treatment in acute ischemic stroke

“…Although our study is unable to address causality, it is conceivable that hyponatremia-at least in part-contributes to morbidity and mortality by negatively affecting the disease course in acute ischemic stroke. For example, He et al showed that hyponatremia was associated with more postthrombolysis hemorrhagic transformations, although they did not report whether this resulted in more neurological deterioration or mortality [21]. In our study, no association between hyponatremia and symptomatic intracerebral hemorrhages in patients treated with either IVT or EVT(+IVT) was identified.…”

“…For example, He et al. showed that hyponatremia was associated with more postthrombolysis hemorrhagic transformations, although they did not report whether this resulted in more neurological deterioration or mortality [21]. In our study, no association between hyponatremia and symptomatic intracerebral hemorrhages in patients treated with either IVT or EVT(+IVT) was identified.…”

“…In this recent study, He et al. found that hyponatremia was associated with poor postthrombolysis outcome (mRS > 2) at 3 months (aOR = 1.65, 95% CI = 1.01–2.68) [21]. In another study in patients with acute ischemic stroke who were treated with EVT, higher admission plasma sodium was associated with lower 3‐month mRS scores (aOR = 0.94, 95% CI = 0.89–0.99) [22].…”

A Novel Nomogram to Predict Symptomatic Intracranial Hemorrhage in Ischemic Stroke Patients After Intravenous Thrombolysis

“…Serum sodium was barely taken into account in scoring systems building or nomogram establishing in the past. He 32 have reported that hyponatremia was associated with post-thrombolysis hemorrhagic transformation. Several previous studies have implicated the disruption of the blood-brain barrier (BBB) and rt-PA-induced reperfusion injury as potential mechanisms behind ICH after rt-PA intravenous thrombolysis.…”

Frequency of Hyponatremia and Its Impact on Prognosis in Ischemic Stroke

“…Hyponatremia has also been associated with acute confusion, nausea, vomiting, seizures, and, in severe cases, coma, followed by death due to brain herniation [ 16 ]. A recent study in 2022 demonstrated that lower serum sodium levels were independently associated with a poor three-month outcome (OR = 1.647; 95% CI = 1.012-2.679) in ischemic stroke patients [ 17 ].…”