Prognostic Significance of Hyponatremia in Acute Stroke: A Systematic Review and Meta-Analysis

Shima, Shogo; Niimi, Yasunari; Moteki, Yosuke; Takahashi, Osamu; Sato, Shinsuke; Inoue, Tatsuya; Okada, Yoshikazu

doi:10.1159/000510751

Cited by 15 publications

(15 citation statements)

References 36 publications

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“…Incidence of hyponatremia in stroke has been reported to be 11–35% in the literature ( Fofi et al, 2012 ; Mahesar et al, 2019 ). Accumulating evidence has demonstrated that hyponatremia is an independent risk factor for poor prognosis and mortality in patients with ischemic stroke ( Mahesar et al, 2019 ; Shima et al, 2020 ). However, very few studies have explored the effect of serum sodium levels on clinical outcomes and the incidence of HT in patients with AIS who received IVT.…”

Section: Introductionmentioning

confidence: 99%

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

Guo

et al. 2022

Front. Mol. Neurosci.

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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.

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Section: Introductionmentioning

confidence: 99%

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

Guo

et al. 2022

Front. Mol. Neurosci.

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“… 1 – 4 Low sodium (Na + ) levels are commonly noticed in neurologic diseases, including stroke, and are present in 38–54% of such patients. 5 – 9 In this setting, hyponatraemia and water balance exhibit detrimental effects on the injured brain and might increase the corresponding mortality by 60%. 6 , 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

A step-by-step guide for the diagnosis and management of hyponatraemia in patients with stroke

Anastasiou

Liamis

Barkas

2023

Therapeutic Advances in Endocrinology

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Hyponatraemia is common in patients with stroke and associated with adverse outcomes and increased mortality risk. The present review presents the underlying causes and provides a thorough algorithm for the diagnosis and management of hyponatraemia in stroke patients. Concomitant diseases and therapies, such as diabetes, chronic kidney disease and heart failure, along with diuretics, antidepressants and proton pump inhibitors are the most common causes of hyponatraemia in community. In the setting of acute stroke, the emergence of hyponatraemia might be attributed to the administration of hypotonic solutions and drugs (ie. mannitol and antiepileptics), poor solute intake, infections, as well as stroke-related conditions or complications, such as the syndrome of inappropriate secretion of antidiuretic hormone, cerebral salt wasting syndrome and secondary adrenal insufficiency. Diagnostically, the initial step is to differentiate hypotonic from non-hypotonic hyponatraemia, usually caused by hyperglycaemia or recent mannitol administration in patients with stroke. Determining urine osmolality, urine sodium level and volume status are the following steps in the differentiation of hypotonic hyponatraemia. Of note, specific parameters, such as fractional uric acid and urea excretion, along with plasma copeptin concentration, may further improve the diagnostic yield. Therapeutic options are based on the duration and symptoms of hyponatremia. In the case of acute or symptomatic hyponatraemia, hypertonic saline administration is recommended. Hypovolaemic chronic hyponatremia is treated with isotonic solution administration. Although fluid restriction remains the first-line treatment for the rest forms of chronic hyponatraemia, therapies increasing renal free water excretion may be necessary. Loop diuretics and urea serve this purpose in patients with stroke, whereas sodium-glucose transport protein-2 inhibitors appear to be a promising therapy. Nevertheless, it is yet unclear whether the appropriate restoration of sodium level improves outcomes in such patients. Randomized trials designed to compare therapeutic strategies in managing hyponatraemia in patients with stroke are required.

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“…Furthermore, management recommendations are not consistent, resulting in diverse, institution-based rather than evidence-based, patient-specific approaches to the management of these disorders. 5 Hyponatraemia (defined as serum sodium levels<135 mmol/L) is frequent in patients who had an acute stroke, 6 and is associated with longer hospitalisation, 4 higher short-term mortality 7 8 and poorer outcomes. 9 10 The cause of this disorder is usually due to syndrome of inappropriate antidiuretic hormone (SIADH), and less frequently, cerebral salt wasting syndrome (CSWS) and inappropriate fluid intake and loss.…”

Section: Introductionmentioning

confidence: 99%

“…Sodium and water perturbations are common in patients who had an acute stroke, affecting approximately 50% of cases 1. These disorders can lead to a wide spectrum of clinical signs and symptoms2 and are associated with increased length of hospitalisation, morbidity and mortality 3 4. The pathophysiology is frequently misunderstood and effective management of these patients remains problematic and often sub-optimal.…”

Section: Introductionmentioning

confidence: 99%

“…Hyponatraemia (defined as serum sodium levels<135 mmol/L) is frequent in patients who had an acute stroke,6 and is associated with longer hospitalisation,4 higher short-term mortality7 8 and poorer outcomes 9 10. The cause of this disorder is usually due to syndrome of inappropriate antidiuretic hormone (SIADH), and less frequently, cerebral salt wasting syndrome (CSWS) and inappropriate fluid intake and loss 11.…”

Section: Introductionmentioning

confidence: 99%

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Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist

et al. 2021

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Sodium and water perturbations, manifesting as hyponatraemia and hypernatraemia, are common in patients who had an acute stroke, and are associated with worse outcomes and increased mortality. Other non-stroke-related causes of sodium and water perturbations in these patients include underlying comorbidities and concomitant medications. Additionally, hospitalised patients who had an acute stroke may receive excessive intravenous hypotonic solutions, have poor fluid intake due to impaired neurocognition and consciousness, may develop sepsis or are administered drugs (eg, mannitol); factors that can further alter serum sodium levels. Sodium and water perturbations can also be exacerbated by the development of endocrine consequences after an acute stroke, including secondary adrenal insufficiency, syndrome of inappropriate antidiuretic hormone secretion and diabetes insipidus. Recently, COVID-19 infection has been reported to increase the risk of development of sodium and water perturbations that may further worsen the outcomes of patients who had an acute stroke. Because there are currently no accepted consensus guidelines on the management of sodium and water perturbations in patients who had an acute stroke, we conducted a systematic review of the literature published in English and in peer-reviewed journals between January 2000 and December 2020, according to PRISMA guidelines, to assess on the current knowledge and clinical practices of this condition. In this review, we discuss the signs and symptoms of hyponatraemia and hypernatraemia, the pathogenesis of hyponatraemia and hypernatraemia, their clinical relevance, and we provide our recommendations for effective treatment strategies for the neurologist in the management of sodium and water perturbations in commonly encountered aetiologies of patients who had an acute stroke.

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Prognostic Significance of Hyponatremia in Acute Stroke: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 36 publications

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

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

A step-by-step guide for the diagnosis and management of hyponatraemia in patients with stroke

Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist

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