Clinical and Predictive Significance of Hyponatremia after Aneurysmal Subarachnoid Hemorrhage

Abstract

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. Turkish Anahtar Kelimeler: Hiponatremi, serebral iskemi, subaraknoid hemoraji, Glasgow outcome skalası Amaç: SAH sonrası hiponatremi çeşitli çalışmalara konu olmuş ve çelişkili bulgular elde edilmiştir. Bu çalışmanın amacı hiponatreminin, gecikmiş serebral iskemi (GSİ) ve kötü klinik sonuçlar ile prediktif korelasyonunu belirlemekti. Materyal ve Metotlar: Ağustos 2008'den Ağustos 2010'a kadar SAH nedeniyle tedavi edilen 82 hastanın hastane çizelgesini retrospektif olarak inceledik. Hastalar hiponatremi ve normonatremi gruplarına ayrıldı. Serum sodyum seviyesinin <135 mmol/l olması hiponatremi olarak tanımlandı. Karşılaştırılan ve analiz edilen bilgilere; demografik özellikler, preoperatif nörolojik durum, anevrizma özellikleri, postoperative yoğun bakım, yatış süresi, GSİ ve hastaneden taburculuktaki klinik sonuçlar dahildi. P<0.05 değerleri anlamlı kabul edildi. Bulgular: SAH olan 32 hasta (39%) hiponatremi geliştirdi. Bu grupta başvuru sırasında WFNS skoru anlamlı şekilde daha yüksekti (p=0.03) ve yoğun bakımda kalış süresi daha uzundu (p=0.001). Geçici veya kalıcı defisit ile GSİ hiponatremi grubunda 20 hastayı (62%) ve normonatremi grubunda 19 hastayı (38%) kapsadı (p=0.03). İkili (binary) lojistik regresyon hiponatreminin GSİ (p=0.03) ve kötü klinik sonuç ile anlamlı korelasyon içinde olduğunu gösterdi (p=0.001). Sonuç: Bu bulgu hiponatreminin GSİ gelişimi ve kötü klinik sonuç için ilave bir prediktör olarak kullanılma ihtimali olduğunu ortaya çıkardı.

Keywords

• Hyponatremia, cerebral ischemia, subarachnoid hemorrhage, Glasgow outcome scale

Clinical and Predictive Significance of Hyponatremia after Aneurysmal Subarachnoid Hemorrhage

Öz

Kaynakça

1. Sherlock M, O’Sullivan E, Agha A, Behan LA, Rawluk D, Brennan P, et al. The incidence and pathophysiology of hyponatraemia after sub- arachnoid hemorrhage. Clin Endocrinol 2006;64:250-4. [CrossRef]
2. Qureshi AI, Suri MF, Sung GY, Straw RN, Yahia AM, Saad M, et al. Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 2002;50:749-56. [CrossRef]
3. Chandy D, Sy R, Aronow W, Lee W N, Maguire G, Murali R. Hypo- natremia and cerebrovascular spasm in aneurysmal subarachnoid hemorrhage. Neurology Ind 2006;54:273-5. [CrossRef]
4. Isotani E, Suzuki R, Tomita K, Hokari M, Monma S, Marumo F, et al. Alterations in plasma concentrations of natriuretic pep- tides and antidiuretic hormone after subarachnoid hemorrhage. Stroke 1994 25:2198-203. [CrossRef]
5. Revilla-Pacheco FR, Herrada-Pineda T, Loyo-Varela M, Modiano-Es- quenazi M. Cerebral salt wasting syndrome in patients with aneurysmal subarachnoid hemorrhage. Neurol Res 2005;27:418-22. [CrossRef]
6. Wijdicks EF, Vermeulen M, ten Haaf JA, Hijdra A, Bakker WH, van Gijn J. Volume depletion and natriuresis in patients with ruptured intracranial aneurysm. Ann Neurol 1985;18:211-6. [CrossRef]
7. Sviri GE, Feinsod M, Soustiel JF. Brain natriuretic peptide and ce- rebral vasospasm in subarachnoid hemorrhage. Clinical and TCD correlations. Stroke 2000;31:118-22. [CrossRef]
8. Berendes E, Walter M, Cullen P, Prien T, Van Aken H, Horsthemke J, et al. Secretion of brain natriuretic peptide in patients with aneurys- mal subarachnoid hemorrhage. Lancet 1997;349:245-9. [CrossRef]

9. Tomida M, Muraki M, Uemura K, Yamasaki K. Plasma concentra- tions of brain natriuretic peptide in patients with subarachnoid hemorrhage. Stroke 1998;29:1584-7. [CrossRef] 245 2012; 29: 243-6 Vrsajkov et al.
10. Hyponatremia after Subarachnoid Hemorrhage