Intensive Care Unit, Royal Melbourne Hospital, Level 5, B Block, Parkville, VIC, 3050, Australia.
Department of Anesthesia and Surgical Intensive Care, Paris Sud University, CHU de Bicetre, Le Kremlin Bicêtre, 78, rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
Neurocrit Care. 2021 Jun;34(3):899-907. doi: 10.1007/s12028-020-01118-8. Epub 2020 Oct 2.
BACKGROUND/OBJECTIVE: Dysnatremia is common in severe traumatic brain injury (TBI) patients and may contribute to mortality. However, serum sodium variability has not been studied in TBI patients. We hypothesized that such variability would be independently associated with mortality.
We collected 6-hourly serum sodium levels for the first 7 days of ICU admission from 240 severe TBI patients in 14 neurotrauma ICUs in Europe and Australia. We evaluated the association between daily serum sodium standard deviation (dNa), an index of variability, and 28-day mortality.
Patients were 46 ± 19 years of age with a median initial GCS of 6 [4-8]. Overall hospital mortality was 28%. Hypernatremia and hyponatremia occurred in 64% and 24% of patients, respectively. Over the first 7 days in ICU, serum sodium standard deviation was 2.8 [2.0-3.9] mmol/L. Maximum daily serum sodium standard deviation (dNa) occurred at a median of 2 [1-4] days after admission. There was a significant progressive decrease in dNa over the first 7 days (coefficient - 0.15 95% CI [- 0.18 to - 0.12], p < 0.001). After adjusting for baseline TBI severity, diabetes insipidus, the use of osmotherapy, the occurrence of hypernatremia, and hyponatremia and center, dNa was significantly independently associated with 28-day mortality (HR 1.27 95% CI (1.01-1.61), p = 0.048).
Our study demonstrates that daily serum sodium variability is an independent predictor of 28-day mortality in severe TBI patients. Further prospective investigations are necessary to confirm the significance of sodium variability in larger cohorts of TBI patients and test whether attenuating such variability confers outcome benefits to such patients.
背景/目的：血清钠紊乱在严重创伤性脑损伤（TBI）患者中很常见，可能与死亡率有关。然而，TBI 患者的血清钠变异性尚未得到研究。我们假设这种变异性与死亡率独立相关。
我们收集了来自欧洲和澳大利亚 14 个神经创伤 ICU 的 240 名严重 TBI 患者在 ICU 入院的前 7 天内每 6 小时的血清钠水平。我们评估了每日血清钠标准差（dNa），即变异性指标，与 28 天死亡率之间的关系。
患者年龄为 46±19 岁，初始 GCS 中位数为 6 [4-8]。总的住院死亡率为 28%。高钠血症和低钠血症分别发生在 64%和 24%的患者中。在 ICU 的前 7 天内，血清钠标准差为 2.8 [2.0-3.9] mmol/L。最大日血清钠标准差（dNa）发生在入院后中位数为 2 [1-4]天。在最初的 7 天内，dNa 呈显著逐渐下降趋势（系数-0.15，95%CI[-0.18 至-0.12]，p<0.001）。在校正基线 TBI 严重程度、尿崩症、使用渗透压治疗、高钠血症和低钠血症以及中心后，dNa 与 28 天死亡率显著独立相关（HR 1.27，95%CI[1.01-1.61]，p=0.048）。
我们的研究表明，严重 TBI 患者的每日血清钠变异性是 28 天死亡率的独立预测因子。需要进一步的前瞻性研究来确认 TBI 患者更大队列中钠变异性的意义，并检验是否减轻这种变异性对这类患者的预后有益。
