Spatenkova Vera, Bradac Ondrej, Kazda Antonin, Suchomel Petr
Neurocenter, Neurologic-Neurosurgical Intensive Care Unit, Regional Hospital, Liberec, Czech Republic.
Neuro Endocrinol Lett. 2011;32(6):879-84.
Hypernatremia is a common sodium dysbalance in neurointensive care which is associated with worse outcome. It can be caused by central diabetes insipidus (cDI) or by other mechanisms, more often from osmotherapy and furosemide. The aim of this study was to determine the incidence of cDI and to analyse outcome as compared with other causes of hypernatremias found in neurointesive care.
We analysed 75 hypernatremic (serum sodium, SNa+ >150 mmol/l) patients (pts) with brain diseases admitted over a period of five years to Neurologic-Neurosurgical Intensive Care Unit (NNICU). Firstly we diagnosed cDI according to measured serum and urine osmolality, eletrolyte free water clearance (EWC) and response to desmopressin acetate. The remaining hypernatremias were categorised as "non cDI". We observed Glasgow Coma Scale (GCS) on onset of hypernatremia, incidence of cerebral complications, Glasgow Outcome Scale (GOS) upon discharge from NNICU and mortality in NNICU.
We found cDI in 8 pts (mean SNa+ 154.8 ± 5.4 mmol/l). Most pts (67) were classified as "non cDI" hypernatremias (mean SNa+ 154.3 ± 3.6 mmol/l). There were no differences in serum sodium (p=0.682), serum osmolality (p=0.476) between the two groups, however patients with cDI indicated low urine osmolality (p=0.001) and positive EWC (p=0.049). We did not find any differences in GCS score on onset of hypernatremia (p=0.395), incidence of cerebral complications (p=0.705), GOS score upon discharge from NNICU (p=0.61) and mortality in NNICU (p=0.638). More patients in the "non cDI" group received antiedematic therapy (p=0.028) and diuretic furosemide (p=0.026). Multivariate logistic regression analysis showed that independent predictors of NNICU mortality was the highest level of serum sodium (Odds ratio, OR 1.13, per 1 mmol/l increase in maximal hypernatremia during NNICU stay, 95% confidence interval, CI 1.01-1.26, p=0.027), and GCS on admission of less than 9 (OR 2.61, 95% CI 1.41-5.44, p=0.003).
Central diabetes insipidus is not a frequent type of hypernatremia in neurointensive care. Prognosis is connected with serum sodium level, not with type of hypernatremia.
高钠血症是神经重症监护中常见的钠失衡，与较差的预后相关。它可由中枢性尿崩症（cDI）或其他机制引起，更多时候是由渗透性疗法和呋塞米导致。本研究的目的是确定cDI的发生率，并与神经重症监护中发现的其他高钠血症原因相比分析预后。
我们分析了在五年期间入住神经科 - 神经外科重症监护病房（NNICU）的75例患有脑部疾病的高钠血症（血清钠，SNa +> 150 mmol / l）患者。首先，我们根据测量的血清和尿渗透压、无电解质水清除率（EWC）以及对醋酸去氨加压素的反应来诊断cDI。其余的高钠血症被归类为“非cDI”。我们观察了高钠血症发作时的格拉斯哥昏迷量表（GCS）、脑部并发症的发生率、NNICU出院时的格拉斯哥预后量表（GOS）以及NNICU的死亡率。
我们在8例患者中发现了cDI（平均SNa + 154.8±5.4 mmol / l）。大多数患者（67例）被归类为“非cDI”高钠血症（平均SNa + 154.3±3.6 mmol / l）。两组之间血清钠（p = 0.682）、血清渗透压（p = 0.476）无差异，然而cDI患者尿渗透压较低（p = 0.001）且EWC为阳性（p = 0.049）。我们在高钠血症发作时的GCS评分（p = 0.395）、脑部并发症的发生率（p = 0.705）、NNICU出院时的GOS评分（p = 0.61）以及NNICU的死亡率（p = 0.638）方面未发现任何差异。“非cDI”组中更多患者接受了抗水肿治疗（p = 0.028）和利尿剂呋塞米（p = 0.026）。多因素逻辑回归分析显示，NNICU死亡率的独立预测因素是血清钠的最高水平（比值比，OR 1.13，NNICU住院期间最大高钠血症每增加1 mmol / l，95％置信区间，CI 1.01 - 1.26，p = 0.027），以及入院时GCS小于9（OR 2.61，95％CI 1.41 - 5.44，p = 0.003）。
中枢性尿崩症在神经重症监护中不是高钠血症的常见类型。预后与血清钠水平相关，而非高钠血症的类型。
