*Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa, Japan †Department of Neurosurgery, Kagawa University Hospital, Miki, Kita, Kagawa, Japan.
Shock. 2017 Nov;48(5):558-563. doi: 10.1097/SHK.0000000000000897.
Dysnatremia commonly occur in the intensive care unit (ICU) management of patients with aneurysmal subarachnoid hemorrhage (SAH). However, detailed management strategies have not been provided even by current guidelines. The purposes of this study were to examine the association of abnormal serum sodium levels with unfavorable neurologic outcomes and to identify the target range of serum sodium in patients with SAH.
We retrospectively reviewed all patients who were consecutively hospitalized with a confirmed diagnosis of SAH between January 2009 and December 2015. Univariate/multivariate analyses were performed to identify the independent predictors of an unfavorable neurologic outcome (modified Rankin scale of 3-6 upon hospital discharge).
There were 131 patients included in this study. Unfavorable neurologic outcomes occurred in 45% of patients. On multiple regression analysis, age, Hunt and Kosnik grade, and serum sodium levels in the ICU at the maximum [odds ratio (OR), 1.18; 95% CI, 1.05-1.35; P < 0.01] and minimum (OR, 0.88; 95% CI, 0.77-0.99; P = 0.048) values were significantly associated with unfavorable neurologic outcomes. The receiver operating characteristic curve analysis showed that the cut-off serum sodium levels were 145 mmol/L for maximum value and 132 mmol/L for minimum value. Patients with hyponatremia and hypernatremia during the first 2 weeks in the ICU accounted for 88.2% of patients with an unfavorable neurologic outcome; whereas, those with normal sodium levels accounted for only 15.6%.
In patients with SAH, both hyponatremia and hypernatremia during ICU management were significantly associated with unfavorable neurologic outcomes.
在动脉瘤性蛛网膜下腔出血（SAH）患者的重症监护病房（ICU）管理中，常出现血钠异常。然而，即使是目前的指南也没有提供详细的管理策略。本研究的目的是研究异常血清钠水平与不良神经结局的关系，并确定 SAH 患者的血清钠目标范围。
我们回顾性分析了 2009 年 1 月至 2015 年 12 月期间连续住院确诊为 SAH 的所有患者。进行单变量/多变量分析以确定不良神经结局（出院时改良 Rankin 量表 3-6 分）的独立预测因素。
本研究共纳入 131 例患者。45%的患者发生不良神经结局。多因素回归分析显示，年龄、Hunt 和 Kosnik 分级以及 ICU 内最大（优势比 [OR]，1.18；95%可信区间 [CI]，1.05-1.35；P<0.01）和最小（OR，0.88；95%CI，0.77-0.99；P=0.048）血清钠水平与不良神经结局显著相关。受试者工作特征曲线分析显示，最大血清钠水平的截断值为 145mmol/L，最小血清钠水平的截断值为 132mmol/L。ICU 前 2 周发生低钠血症和高钠血症的患者中，88.2%的患者出现不良神经结局，而血清钠水平正常的患者仅占 15.6%。
在 SAH 患者中，ICU 期间的低钠血症和高钠血症均与不良神经结局显著相关。
