Beseoglu Kerim, Etminan Nima, Steiger Hans-Jakob, Hänggi Daniel
Department of Neurosurgery, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
Department of Neurosurgery, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
Clin Neurol Neurosurg. 2014 Aug;123:164-8. doi: 10.1016/j.clineuro.2014.05.022. Epub 2014 Jun 2.
Sodium dysregulation in the course after aneurysmal subarachnoid hemorrhage (aSAH) has been identified as one contributor to adverse clinical outcome. However, the correlation of acute dysnatremia and early brain injury (EBI) remains unclear. We investigated the early course and prognostic relevance of changes in serum sodium concentrations and its relation to EBI after aSAH.
Retrospectively, the serum sodium concentration (SSC) of 264 patients with aSAH was analyzed. The first SSC was obtained within 8h after initial ictus and then repeatedly analyzed every 8h over the first five days. Incidence of hypernatremia (defined as SSC>145mmol/l) was correlated with initial neurological condition according to World Federation of Neurological Surgeons grade (WFNS), incidence of delayed cerebral ischemia (DCI) and clinical outcome at 12 month according to modified Rankin Scale (mRS).
Within 56h, 82 patients (31.1%) developed hypernatremia which correlated significantly with initial neurological condition (p<0.001). Initial SSC within 8h after SAH did not correlate with patient outcome at 12 month (r=-0.026, p=0.694), however SSC obtained 56h after ictus did significantly (r=0.365, p<0.001; OR 4.14 95% CI (1.84-9.31)). A correlation with the incidence of DCI was not found (r=0.079, p=0.217).
The occurrence of hypernatremia within 56h after aSAH was shown to be an independent predictor for poor neurological outcome. Early serum sodium levels after aSAH can be considered as surrogate markers to predict outcome after aSAH irrespective to the occurrence of DCI. However, prospective studies are necessary to validate this concept.
动脉瘤性蛛网膜下腔出血（aSAH）病程中的钠代谢紊乱已被确定为不良临床结局的一个促成因素。然而，急性钠血症与早期脑损伤（EBI）之间的相关性仍不清楚。我们研究了aSAH后血清钠浓度变化的早期病程及其与EBI的关系以及预后相关性。
回顾性分析264例aSAH患者的血清钠浓度（SSC）。首次SSC在首次发作后8小时内获得，然后在头五天内每8小时重复分析一次。高钠血症的发生率（定义为SSC>145mmol/L）根据世界神经外科医师联合会分级（WFNS）与初始神经状况相关，延迟性脑缺血（DCI）的发生率以及根据改良Rankin量表（mRS）在12个月时的临床结局相关。
在56小时内，82例患者（31.1%）发生高钠血症，这与初始神经状况显著相关（p<0.001）。SAH后8小时内的初始SSC与12个月时的患者结局无关（r=-0.026，p=0.694），然而发作后56小时获得的SSC则显著相关（r=0.365，p<0.001；OR 4.14 95%CI（1.84-9.31））。未发现与DCI发生率相关（r=0.079，p=0.217）。
aSAH后56小时内发生高钠血症被证明是神经功能预后不良的独立预测因素。aSAH后的早期血清钠水平可被视为预测aSAH后结局的替代标志物，而与DCI的发生无关。然而，需要前瞻性研究来验证这一概念。
