Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.

Harrois A; Anstey JR; van der Jagt M; Taccone FS; Udy AA; Citerio G; Duranteau J; Ichai C; Badenes R; Prowle JR; Ercole A; Oddo M; Schneider A; Wolf S; Helbok R; Nelson DW; Cooper DJ; Bellomo R

doi:10.1007/s12028-020-01118-8

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Journal article

Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.

Harrois A Intensive Care Unit, Royal Melbourne Hospital, Level 5, B Block, Parkville, VIC, 3050, Australia. harroisanatole@yahoo.fr.
Anstey JR Intensive Care Unit, Royal Melbourne Hospital, Level 5, B Block, Parkville, VIC, 3050, Australia.
van der Jagt M Department of Intensive Care Adults, Erasmus MC-University Medical Center, Dr Molewaterplein 40, 3015 GD, Po Box 2040, 3000 CA, Rotterdam, The Netherlands.
Taccone FS Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
Udy AA Intensive Care Unit, The Alfred Hospital, Main Ward Block, Level 1, Commercial Road, Melbourne, VIC, 3004, Australia.
Citerio G School of Medicine and Surgery, University Milano Bicocca - Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy.
Duranteau J 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.
Ichai C Center hospitalier Universitaire de Nice, Service de Réanimation polyvalente, Hôpital Pasteur 2, CHU de Nice, Université Côte d'Azur, 30 Voie Romaine, 06000, Nice, France.
Badenes R Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, Department of Surgery, University of Valencia, Valencia, Spain.
Prowle JR Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
Ercole A Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Oddo M Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Center Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, 1011, Lausanne, Switzerland.
Schneider A Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Center Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, 1011, Lausanne, Switzerland.
Wolf S Department of Neurosurgery, Charité Universitätsmedizin Neuro Intensive Care Unit 102i, Campus Charité Mitte (CCM), Charitéplatz 1, 10117, Berlin, Germany.
Helbok R Neurocritical Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
Nelson DW Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, 171 76, Stockholm, Sweden.
Cooper DJ Intensive Care Unit, The Alfred Hospital, Main Ward Block, Level 1, Commercial Road, Melbourne, VIC, 3004, Australia.
Bellomo R Intensive Care Unit, Royal Melbourne Hospital, Level 5, B Block, Parkville, VIC, 3050, Australia.

2020-10-03

Published in:

Neurocritical care. - 2020

English 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.

METHODS
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 (dNaSD), an index of variability, and 28-day mortality.

RESULTS
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 (dNaSD) occurred at a median of 2 [1-4] days after admission. There was a significant progressive decrease in dNaSD 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, dNaSD was significantly independently associated with 28-day mortality (HR 1.27 95% CI (1.01-1.61), p = 0.048).

CONCLUSIONS
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.

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