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

Jeremy Cohen, PhD; Anthony Delaney, PhD; James Anstey, MD; Matthew Anstey, MD; Deborah Barge, RN; Rinaldo Bellomo, PhD; Vishnu Bhardwa, MD; Gail Brinkerhoff, RN; Jasmin Board, RN; Anna Campain, PhD; D. James Cooper, PhD; Gian Luca Di Tanna, PhD; Mark Finnis, MBiostat; Emily Fitzgerald, MD; Oliver Flower, MD; Paul Healey, RN; Anna Hunt, RN; Cassie Lawrence, RN; Jan Merthens, RN; Lynette Newby, RN; David Pearson, MD; Eamon Raith, PhD; Yvonne Robertson, RN; Sacha Schweikert, MD; Therese Starr, RN; Mandy Tallott, RN; Andrew van der Poll, MD; Paul Young, PhD; Andrew Udy, PhD

doi:10.1097/CCE.0000000000000445

Critical Care Explorations (Jun 2021)

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

Jeremy Cohen, PhD,
Anthony Delaney, PhD,
James Anstey, MD,
Matthew Anstey, MD,
Deborah Barge, RN,
Rinaldo Bellomo, PhD,
Vishnu Bhardwa, MD,
Gail Brinkerhoff, RN,
Jasmin Board, RN,
Anna Campain, PhD,
D. James Cooper, PhD,
Gian Luca Di Tanna, PhD,
Mark Finnis, MBiostat,
Emily Fitzgerald, MD,
Oliver Flower, MD,
Paul Healey, RN,
Anna Hunt, RN,
Cassie Lawrence, RN,
Jan Merthens, RN,
Lynette Newby, RN,
David Pearson, MD,
Eamon Raith, PhD,
Yvonne Robertson, RN,
Sacha Schweikert, MD,
Therese Starr, RN,
Mandy Tallott, RN,
Andrew van der Poll, MD,
Paul Young, PhD,
Andrew Udy, PhD

Affiliations

Jeremy Cohen, PhD: 1 The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Anthony Delaney, PhD: 1 The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
James Anstey, MD: 7 Royal Melbourne Hospital, Melbourne, VIC, Australia.
Matthew Anstey, MD: 8 Sir Charles Gairdner Hospital, Perth, WA, Australia.
Deborah Barge, RN: 7 Royal Melbourne Hospital, Melbourne, VIC, Australia.
Rinaldo Bellomo, PhD: 9 Austin Health, Melbourne, VIC, Australia.
Vishnu Bhardwa, MD: 7 Royal Melbourne Hospital, Melbourne, VIC, Australia.
Gail Brinkerhoff, RN: 10 Hunter New England Health, Wallsend, NSW, Australia.
Jasmin Board, RN: 11 The Alfred Hospital, Melbourne, VIC, Australia.
Anna Campain, PhD: 1 The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
D. James Cooper, PhD: 11 The Alfred Hospital, Melbourne, VIC, Australia.
Gian Luca Di Tanna, PhD: 1 The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Mark Finnis, MBiostat: 12 Royal Adelaide Hospital, Adelaide, SA, Australia.
Emily Fitzgerald, MD: 5 Royal North Shore Hospital, Sydney, NSW, Australia.
Oliver Flower, MD: 5 Royal North Shore Hospital, Sydney, NSW, Australia.
Paul Healey, RN: 10 Hunter New England Health, Wallsend, NSW, Australia.
Anna Hunt, RN: 13 Wellington Hospital, Wellington, New Zealand.
Cassie Lawrence, RN: 13 Wellington Hospital, Wellington, New Zealand.
Jan Merthens, RN: 14 Christchurch Hospital, Christchurch, New Zealand.
Lynette Newby, RN: 15 Auckland City Hospital, Auckland, New Zealand.
David Pearson, MD: 16 Gold Coast University Hospital, Gold Coast, QLD, Australia.
Eamon Raith, PhD: 17 Discipline of Acute Care Medicine, Department of Surgical Specialties, The University of Adelaide, Adelaide, SA, Australia.
Yvonne Robertson, RN: 10 Hunter New England Health, Wallsend, NSW, Australia.
Sacha Schweikert, MD: 19 Royal Perth Hospital, Perth, WA, Australia.
Therese Starr, RN: 2 Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia.
Mandy Tallott, RN: 16 Gold Coast University Hospital, Gold Coast, QLD, Australia.
Andrew van der Poll, MD: 15 Auckland City Hospital, Auckland, New Zealand.
Paul Young, PhD: 20 Medical Research Institute of New Zealand and Intensive Care Unit, Wellington, Hospital, Wellington, New Zealand.
Andrew Udy, PhD: 11 The Alfred Hospital, Melbourne, VIC, Australia.

DOI: https://doi.org/10.1097/CCE.0000000000000445
Journal volume & issue: Vol. 3, no. 6
p. e0445

Abstract

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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.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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