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

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 col...

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Autores: 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, TBI Collaborative
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Recursos:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p15231
Acesso em linha:https://incliva.portalinvestigacion.com/publicaciones/15231
Access Level:acceso abierto
Palavra-chave:Hypernatremia
Hyponatremia
Osmotherapy
Sodium variability
Traumatic brain injury
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spelling Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.Harrois, AAnstey, JRvan der Jagt, MTaccone, FSUdy, AACiterio, GDuranteau, JIchai, CBadenes, RProwle, JRErcole, AOddo, MSchneider, AWolf, SHelbok, RNelson, DWCooper, DJBellomo, RTBI CollaborativeHypernatremiaHyponatremiaOsmotherapySodium variabilityTraumatic brain injuryBACKGROUND/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 (dNa(SD)), 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 (dNa(SD)) occurred at a median of 2 [1-4] days after admission. There was a significant progressive decrease in dNa(SD) 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(SD) 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.HUMANA PRESS INC2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/15231Neurocritical CareISSN: 15416933ISSNe: 15560961reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p152312026-06-07T16:35:31Z
dc.title.none.fl_str_mv Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.
title Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.
spellingShingle Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.
Harrois, A
Hypernatremia
Hyponatremia
Osmotherapy
Sodium variability
Traumatic brain injury
title_short Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.
title_full Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.
title_fullStr Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.
title_full_unstemmed Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.
title_sort Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.
dc.creator.none.fl_str_mv 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
TBI Collaborative
author Harrois, A
author_facet 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
TBI Collaborative
author_role author
author2 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
TBI Collaborative
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Hypernatremia
Hyponatremia
Osmotherapy
Sodium variability
Traumatic brain injury
topic Hypernatremia
Hyponatremia
Osmotherapy
Sodium variability
Traumatic brain injury
description 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 (dNa(SD)), 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 (dNa(SD)) occurred at a median of 2 [1-4] days after admission. There was a significant progressive decrease in dNa(SD) 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(SD) 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.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/15231
url https://incliva.portalinvestigacion.com/publicaciones/15231
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv HUMANA PRESS INC
publisher.none.fl_str_mv HUMANA PRESS INC
dc.source.none.fl_str_mv Neurocritical Care
ISSN: 15416933
ISSNe: 15560961
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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