Dysnatremia and 6-Month Functional Outcomes in Critically Ill Patients With Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study.

Autor:	Cohen J; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.; The Wesley Hospital, Brisbane, QLD, Australia.; The University of Queensland, Brisbane, QLD, Australia., Delaney A; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.; Royal North Shore Hospital, Sydney, NSW, Australia.; Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia., Anstey J; Royal Melbourne Hospital, Melbourne, VIC, Australia., Anstey M; Sir Charles Gairdner Hospital, Perth, WA, Australia., Barge D; Royal Melbourne Hospital, Melbourne, VIC, Australia., Bellomo R; Austin Health, Melbourne, VIC, Australia., Bhardwa V; Royal Melbourne Hospital, Melbourne, VIC, Australia., Brinkerhoff G; Hunter New England Health, Wallsend, NSW, Australia., Board J; The Alfred Hospital, Melbourne, VIC, Australia., Campain A; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia., Cooper DJ; The Alfred Hospital, Melbourne, VIC, Australia., Di Tanna GL; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia., Finnis M; Royal Adelaide Hospital, Adelaide, SA, Australia., Fitzgerald E; Royal North Shore Hospital, Sydney, NSW, Australia., Flower O; Royal North Shore Hospital, Sydney, NSW, Australia., Healey P; Hunter New England Health, Wallsend, NSW, Australia., Hunt A; Wellington Hospital, Wellington, New Zealand., Lawrence C; Wellington Hospital, Wellington, New Zealand., Merthens J; Christchurch Hospital, Christchurch, New Zealand., Newby L; Auckland City Hospital, Auckland, New Zealand., Pearson D; Gold Coast University Hospital, Gold Coast, QLD, Australia., Raith E; Discipline of Acute Care Medicine, Department of Surgical Specialties, The University of Adelaide, Adelaide, SA, Australia.; Department of Neurocritical Care Medicine, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom., Robertson Y; Hunter New England Health, Wallsend, NSW, Australia., Schweikert S; Royal Perth Hospital, Perth, WA, Australia., Starr T; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia., Tallott M; Gold Coast University Hospital, Gold Coast, QLD, Australia., van der Poll A; Auckland City Hospital, Auckland, New Zealand., Young P; Medical Research Institute of New Zealand and Intensive Care Unit, Wellington, Hospital, Wellington, New Zealand., Udy A; The Alfred Hospital, Melbourne, VIC, Australia.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2021 Jun 08; Vol. 3 (6), pp. e0445. Date of Electronic Publication: 2021 Jun 08 (Print Publication: 2021).
DOI:	10.1097/CCE.0000000000000445
Abstrakt:	Objectives: To investigate the association between plasma sodium concentrations and 6-month neurologic outcome in critically ill patients with aneurysmal subarachnoid hemorrhage. Design: Prospective cohort study. Setting: Eleven ICUs in Australia and New Zealand. Participants: Three-hundred fifty-six aneurysmal subarachnoid hemorrhage patients admitted to ICU between March 2016 and June 2018. The exposure variable was daily measured plasma sodium. Interventions: None. Measurements and Main Results: Six-month neurologic outcome as measured by the modified Rankin Scale. A poor outcome was defined as a modified Rankin Scale greater than or equal to 4. The mean age was 57 years (± 12.6 yr), 68% were female, and 32% ( n = 113) had a poor outcome. In multivariable analysis, including age, illness severity, and process of care measures as covariates, higher mean sodium concentrations (odds ratio, 1.17; 95% CI, 1.05-1.29), and greater overall variability-as measured by the sd (odds ratio, 1.53; 95% CI, 1.17-1.99)-were associated with a greater likelihood of a poor outcome. Multivariable generalized additive modeling demonstrated, specifically, that a high initial sodium concentration, followed by a gradual decline from day 3 onwards, was also associated with a poor outcome. Finally, greater variability in sodium concentrations was associated with a longer ICU and hospital length of stay: mean ICU length of stay ratio (1.13; 95% CI, 1.07-1.20) and mean hospital length of stay ratio (1.08; 95% CI, 1.01-1.15). Conclusions: In critically ill aneurysmal subarachnoid hemorrhage patients, higher mean sodium concentrations and greater variability were associated with worse neurologic outcomes at 6 months, despite adjustment for known confounders. Interventional studies would be required to demonstrate a causal relationship. Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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