Chendrasekhar Akella, Chow Priscilla T, Cohen Douglas, Akella Krishna, Vadali Vinay, Bapatla Alok, Patwari Jakey, Rubinshteyn Vladimir, Harris Loren
Department of Surgery, Richmond University Medical Center, Staten Island, NY, USA.
Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Neuropsychiatr Dis Treat. 2020 Mar 25;16:801-806. doi: 10.2147/NDT.S233389. eCollection 2020.
In the setting of cerebral injury, cerebral salt wasting (CSW) is a potential cause of hyponatremia, which contributes to adverse effects and mortality.
The primary objective of this study was to evaluate the clinical outcomes of severe traumatic brain injury (TBI) patients complicated by CSW.
A retrospective data analysis was performed on data collected from patients with TBI with an abbreviated injury scale (AIS) greater than 3. Data was divided into 2 groups of patients with CSW and those without. The primary endpoint was incidence of adverse effects of CSW in regard to injury severity score (ISS), hospital length of stay (HLOS), ventilator days, ICU length of stay (ICU LOS) and survival to discharge. Data was analyzed using a one-way analysis of variance (ANOVA).
A total of 310 consecutive patients with severe head injury (anatomic injury score 3 or greater) were evaluated over a 3-year period. A total of 125 of the 310 patients (40%) were diagnosed with cerebral salt wasting as defined by hyponatremia with appropriate urinary output and salt replacement. Patients with CSW had poorer outcomes in regard to ISS (21.8 vs 14.2, p<0.0001), HLOS (14.1 vs 3.5, p<0.0001), ventilator days (5.0 vs 0.45, p<0.0001), ICU LOS (8.5 vs 1.6, p<0.0001), and survival to discharge (88% vs 99%, p<0.0001).
Common adverse effects of CSW were noted in this study. Patients with TBI have a predilection towards development of CSW and consequently have poorer outcomes including increased morbidity and mortality. Data is sparse on the duration of CSW and degree of hyponatremia over time. Larger, comparative studies need to be performed to investigate the hyponatremic patient population and the clinical outcomes of those who present with CSW.
在脑损伤情况下，脑性盐耗综合征（CSW）是低钠血症的一个潜在原因，会导致不良后果和死亡。
本研究的主要目的是评估并发CSW的重度创伤性脑损伤（TBI）患者的临床结局。
对从简明损伤定级标准（AIS）大于3的TBI患者收集的数据进行回顾性数据分析。数据分为CSW患者组和非CSW患者组。主要终点是CSW在损伤严重程度评分（ISS）、住院时间（HLOS）、机械通气天数、重症监护病房住院时间（ICU LOS）和出院生存率方面的不良反应发生率。使用单因素方差分析（ANOVA）对数据进行分析。
在3年期间共评估了310例连续的重度颅脑损伤患者（解剖损伤评分3或更高）。310例患者中有125例（40%）被诊断为脑性盐耗综合征，定义为低钠血症伴适当尿量和盐分补充。CSW患者在ISS（21.8对14.2，p<0.0001）、HLOS（14.1对3.5，p<0.0001）、机械通气天数（5.0对0.45，p<0.0001）、ICU LOS（8.5对1.6，p<0.0001）以及出院生存率（88%对99%，p<0.0001）方面结局更差。
本研究中注意到了CSW的常见不良反应。TBI患者易发生CSW，因此结局更差，包括发病率和死亡率增加。关于CSW持续时间和低钠血症随时间变化程度的数据很少。需要进行更大规模的比较研究来调查低钠血症患者群体以及出现CSW患者的临床结局。
