Impact of Dysnatremia and Dyskalemia on Prognosis in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study

Abstract

Background: Electrolyte disturbance is one of the complications of subarachnoid hemorrhage (SAH) and its prognostic value is not fully understood. The focus of this study is to evaluate the impact of dysnatremia and dyskalemia on functional outcomes in patients with aneurysmal SAH. Materials and methods: Patients with spontaneous aneurysmal SAH who were admitted to our intensive care unit (ICU) between 1st January 2011 and 31st December 2016 were included. Demographic data, biochemical parameters from days 1 to day 11 of ICU admission, disease severity, and clinical outcome were recorded. The prognosis was estimated using the Glasgow outcome scale (GOS) at 3 months after the initial insult. Results: A total of 244 patients were included in this study. There were 139 patients (57.0%) with hyponatremia (Na < 135 mmol/L) while 82 patients (33.6%) had hypernatremia (Na >146 mmol/L). Hyponatremia, hypernatremia, and sodium fluctuation >12 mmol/L were more commonly found in those patients with poor outcome. However, both hypokalemia and hyperkalemia were not shown to have a significant effect on the patient's prognosis. Logistic regression analysis identified the following independent predictors of poor outcome (GOS 1-3 at 3 months): age >55 years old, acute physiology and chronic health evaluation IV (APACHE IV) score >50, World Federation of Neurosurgical Societies (WFNS) grade >3, Fisher grade >2, presence of intracranial hemorrhage (ICH)/intraventricular hemorrhage (IVH), use of mannitol, use of loop diuretic aneurysms, involving posterior circulation, and hypernatremia >146 mmol/L. Conclusion: Hypernatremia, but not hyponatremia, in patients with aneurysmal SAH is associated with poor outcome. Both hypokalemia and hyperkalemia were not shown to have a significant effect on the patient's prognosis. Further studies are required to determine whether the treatment of dysnatremia can influence outcomes. Clinical significance: Dysnatremia and dyskalemia are common in patients with aneurysmal SAH, but only hypernatremia is associated with poor outcome. Further studies are required to determine whether the treatment of dysnatremia can influence outcomes.

Association of Plasma Glucose to Potassium Ratio and Mortality After Aneurysmal Subarachnoid Hemorrhage

“…Only 20 patients in our study had moderate hypokalemia and no patients with severe hypokalemia. Tam et al found that neither hypokalemia nor hyperkalemia were independent predictors for poor outcome at 3 months after SAH onset ( 22 ). By contrast, others found that only 2% of the patients included were hypokalemic on ED admission, and hypokalemia in the subacute phase (days 7–10) correlated with poor outcome at 3 months after discharge ( 23 ).…”

Pituitary Hormonal Disturbances in Aneurysmal Subarachnoid Hemorrhage

“…33 Both sodium disorders are associated with worse neurological outcomes, especially hypernatremia. [35][36][37][38][39] Furthermore, a recent cohort study showed that greater variability of sodium concentration is also associated with poor neurological outcome. 40 However, sodium disorders are apparently not associated with an increased risk of vasospasm after SAH.…”

The Role of Sodium and Glucose in the Prognosis of Patients with Aneurysmal Subarachnoid Hemorrhage: A Literature Review of New Evidence

“…Furthermore, concentrations > 155 mmol/L were associated with unfavorable outcomes within 3 months. 10 More broadly, a study showed that sodium in the blood, in addition to rebleeding, is an independent risk factor, leading to poor prognosis. 14 The role of hyponatremia as a predictor is controversial.…”

“…In most articles, it is demonstrated that it has no prognostic value in the short or long term, especially in terms of mortality. 10,11,15,16 Kieninger et al 17 even demonstrated that the rate of poor outcome at discharge from the intensive care unit (ICU), 6 months after the bleeding event, was significantly lower in patients with moderate hyponatremia (125-129 mmol/L), allowing only a limited conclusion, as the diagnosis of hyponatremia regularly led to early and elaborate measures to achieve rapid normalization of the sodium level and maintain normonatremia in the later course of ICU treatment. A pathophysiological hypothesis proposed by Tam et al 10 would be the ability of brain neurons to adapt to the situation of hyponatremia, in a self-regulation mechanism, managing to reach a state of functional stability in less than 24 hours.…”

“…Increased sodium variability was associated with a longer hospital stay 19 and, between the 1 st and 3 rd days, it was associated with higher in-hospital mortality. 16 Also, Tam et al 10 detected that a variation > 12 mmol/L of sodium during hospitalization could be associated with a worse patient outcome, represented by states 1 to 3 of the Glasgow Outcome Scale in the 3 months following aSAH. Furthermore, within 14 days of an aSAH episode andan6 months of hospital discharge, it has been associated with the development of symptomatic vasoespasm 20 and poor neurological outcome, 19 respectively, with progressive decreases in serum sodium being found to precede such complications.…”