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Title: Dysnatremia and 6-Month Functional Outcomes in Critically Ill Patients With Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study.
Austin Authors: Cohen, Jeremy;Delaney, Anthony;Anstey, James;Anstey, Matthew;Barge, Deborah;Bellomo, Rinaldo ;Bhardwa, Vishnu;Brinkerhoff, Gail;Board, Jasmin;Campain, Anna;Cooper, D James;Di Tanna, Gian Luca;Finnis, Mark;Fitzgerald, Emily;Flower, Oliver;Healey, Paul;Hunt, Anna;Lawrence, Cassie;Merthens, Jan;Newby, Lynette;Pearson, David;Raith, Eamon;Robertson, Yvonne;Schweikert, Sacha;Starr, Therese;Tallott, Mandy;van der Poll, Andrew;Young, Paul;Udy, Andrew
Affiliation: Department of Neurocritical Care Medicine, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
Auckland City Hospital, Auckland, New Zealand
Medical Research Institute of New Zealand and Intensive Care Unit, Wellington, Hospital, Wellington, New Zealand
Royal Melbourne Hospital, Melbourne, VIC, Australia
Discipline of Acute Care Medicine, Department of Surgical Specialties, The University of Adelaide, Adelaide, SA, Australia
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
Sir Charles Gairdner Hospital, Perth, WA, Australia
Austin Health
Hunter New England Health, Wallsend, NSW, Australia
The Alfred Hospital, Melbourne, VIC, Australia
Royal Adelaide Hospital, Adelaide, SA, Australia
Gold Coast University Hospital, Gold Coast, QLD, Australia
Royal Perth Hospital, Perth, WA, Australia
Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
The Wesley Hospital, Brisbane, QLD, Australia
The University of Queensland, Brisbane, QLD, Australia
Wellington Hospital, Wellington, New Zealand
Christchurch Hospital, Christchurch, New Zealand
Issue Date: Jun-2021
Date: 2021-06-08
Publication information: Critical Care Explorations 2021; 3(6): e0445
Abstract: To investigate the association between plasma sodium concentrations and 6-month neurologic outcome in critically ill patients with aneurysmal subarachnoid hemorrhage. Prospective cohort study. Eleven ICUs in Australia and New Zealand. 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. None. 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). 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.
DOI: 10.1097/CCE.0000000000000445
Journal: Critical Care Explorations
PubMed URL: 34124687
Type: Journal Article
Subjects: aneurysmal subarachnoid hemorrhage
critical care
Appears in Collections:Journal articles

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