Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Ob
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ORIGINAL WORK
Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study Anatole Harrois1,2* , James R. Anstey1, Mathieu van der Jagt3, Fabio S. Taccone4, Andrew A. Udy5,15, Giuseppe Citerio6, Jacques Duranteau2, Carole Ichai7, Rafael Badenes8, John R. Prowle9, Ari Ercole10, Mauro Oddo11, Antoine Schneider11, Stefan Wolf12, Raimund Helbok13, David W. Nelson14, D. Jamie Cooper5,15, Rinaldo Bellomo1,15,16,17 and The TBI Collaborative © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract 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 d NaSD over the first 7 days (coefficient − 0.15 95% CI [− 0.18 to − 0.12], p 145 mmol/L, h
24 [12–60]
Hyponatremia within the first 7 days Hyponatremia 1 mmol/L/h, n(%)
55/5566 (1.0)
Serum sodium decrease > 0.5 mmol/L/h, n(%)
186/5566 (3.3)
Serum sodium decrease > 1.0 mmol/L/h, n(%)
26/5566 (0.5)
Serum sodium according to center within the first 7 days Mean serum sodium (all centers, Namean), mmol/L
143 ± 5
Mean serum sodium ( centerhigh), mmol/L
149 ± 6
Mean serum sodium ( centerlow), mmol/L
138 ± 4
Serum sodium extreme values within the first 7 days Minimum serum sodium (Namin), mmol/L
137 [135–140]
Maximum serum sodium (Namax), mmol/L
147 [144–152]
Serum sodium variability within the first 7 days Standard deviation of serum sodium ( NaSD), mmol/L
2.8 [2.0–3.9]
APACHE = Acute Physiology and Chronic Health Evaluation, EVD = extraventricular drain, GCS = Glasgow Coma Scale, ICU = intensive care unit, IMPACT = International Mission for Prognosis and Analysis of Clinical Trials in TBI, ISS = Injury Severity Score; centerhigh = the single center with the highest mean serum sodium level over the first 7 days of admission, centerlow = the single center with the lowest mean serum sodium level over the first 7 days of admission. Namax = maximum serum sodium over 7 days of admission, Namean = mean serum sodium over 7 days of admission, Namin = minimum
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