J Neurointensive Care.  2021 Apr;4(1):30-35. 10.32587/jnic.2021.00346.

Association of Hyponatremia and Clinical Prognosis in Neuro Critically Ill Patients

• Ha C
• Ryu JA

• KMID: 2555047
• DOI: http://doi.org/10.32587/jnic.2021.00346

Abstract

Objective
To investigate the impact of hyponatremia severity on in-hospital mortality of neuro critically ill patients.
Methods
This was a retrospective, observational study of patients who were admitted at a tertiary university hospital, Seoul, Republic of Korea, neurosurgical intensive care unit (ICU) from January 2013 to December 2019. We included neurocritically ill patients whose serum sodium concentrations were obtained during the ICU admission. The primary endpoint was in-hospital mortality.
Results
A total of 903 patients were included in the final analysis. Hyponatremia was detected in 359 (39.8%) patients. There was no significant difference in in-hospital mortality between the no hyponatremia group and the hyponatremia group (8.8% vs. 9.7%, p = 0.724). However, the length of ICU stay was longer in the hyponatremia group than no hyponatremia group (141.8 ± 89.3 hr vs. 282.3± 295.9 hr, p < 0.001). In the multivariable analysis, severe hyponatremia (adjusted odds ratio [OR]: 5.41, 95% confidence interval [CI]: 1.23 – 20.54), malignancy (adjusted OR: 3.45, 95% CI: 1.29 – 9.72), continuous renal replacement therapy (adjusted OR: 6.15, 95% CI: 1.65 – 23.38), invasive intracranial pressure monitoring (adjusted OR: 0.39, 95% CI: 0.17 – 0.83) and Glasgow Coma Scale on ICU admission (adjusted OR: 0.6, 95% CI: 0.52 – 0.69) were significantly associated with in-hospital mortality.
Conclusions
Based on our findings, mild to moderate hyponatremia were not associated with clinical outcomes. However, severe hyponatremia was significantly associated with in-hospital mortality. Therefore, adequate and timely regulation of serum sodium level is important for favorable prognosis and survival of neurocritically ill patients.

Keyword

Hyponatremia; Prognosis; Neurosurgery; Intensive care unit