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A predictive value of hyponatremia for poor outcome and cerebral infarction in high-grade aneurysmal subarachnoid haemorrhage patients
  1. B Zheng1,
  2. Y Qiu1,
  3. H Jin1,
  4. L Wang1,
  5. X Chen1,
  6. C Shi2,
  7. S Zhao1
  1. 1Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, The People's Republic of China
  2. 2Section of Neurosurgery, Department of Surgery, The University of Chicago Medical Center and Pritzker School of Medicine, Chicago, Illinois, USA
  1. Correspondence to Shiguang Zhao, Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150001, The People's Republic of China; guangsz{at}hotmail.com
  2. Changbin Shi, Section of Neurosurgery, Department of Surgery, The University of Chicago Medical Center and Pritzker School of Medicine, 5841 South Maryland Avenue (MC 3026), Chicago, IL 60637, USA; changbinshi{at}uchicago.edu

Abstract

Background The clinical significance of hyponatremia has not been investigated in high-grade aneurysmal subarachnoid haemorrhage (aSAH) patients. Thus, we assessed the predictive value of hyponatremia for poor outcome or cerebral infarction in high grade patients (the World Federation of Neurological Surgeons Scale (WFNS) grade 4 or 5) after aSAH.

Methods Patients with WFNS grade 4 or 5 after aSAH were selected into this study between January 2005 and January 2008. In the same period, patients with WFNS grade 1, 2 or 3 after aSAH (low grade) were also chosen into this study. Hyponatremia was determined with serum sodium measurements obtained within 9 days after aSAH. Prognosis of patients was estimated with Glasgow Outcome Scale at 3 months. The relationship between hyponatremia and poor outcome and association of hyponatremia and cerebral infarction were analysed, respectively.

Results A total of 124 high-grade patients were included in this study. Of those, 78 patients developed hyponatremia. Hyponatremia developed in 32.3% of cases between days 1 and 3 after aSAH, and 30.6% developed hyponatremia after 3 days post-aSAH. Multivariable analysis revealed that hyponatremia was not correlated with poor outcome in high-grade aSAH patients. Furthermore, only late-onset hyponatremia was correlated with cerebral infarction in these patients. Meanwhile, there was no significant correlation between hyponatremia and poor outcome or cerebral infarction in 259 low-grade aSAH patients.

Conclusions Hyponatremia does not predict poor outcome in all-grade aSAH patients. However, late-onset hyponatremia in high-grade aSAH patients is associated with cerebral infarction. Therefore, the appropriate management of hyponatremia could be beneficial in those patients.

  • Aneurysmal subarachnoid haemorrhage
  • cerebral infarction
  • hyponatremia
  • intracranial aneurysm
  • prognosis
  • cerebrovascular disease
  • intensive care
  • neurochemistry
  • neurosurgery
  • stroke

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Footnotes

  • Bingjie Zheng and Yong Qiu contributed equally to this work.

  • Funding National Key Technology R&D Program during the 11th Five-Year Plan Period (2006BAI01A12 to S.Z).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Harbin Medical University Institutional Review Board, China.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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