Decreased serum sodium levels predict symptomatic vasospasm in patients with subarachnoid hemorrhage

Uozumi, Yoichi; Mizobe, Takashi; Miyamoto, Hirohito; Ashida, Noriaki; Katsube, Tsuyoshi; Tatsumi, Shotaro; Nakamura, Mitsugu; Kohmura, Eiji

doi:10.1016/j.jocn.2017.08.037

Cited by 24 publications

(12 citation statements)

References 35 publications

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“…A single-center retrospective observational study showed that serum sodium concentrations increased for the first few days and decreased to the nadir level at 6–12 days [ 60 ]. A similar trend was observed in another retrospective study [ 61 ].…”

Section: Reviewsupporting

confidence: 90%

Aneurysmal subarachnoid hemorrhage: intensive care for improving neurological outcome

Okazaki

Kuroda

2018

j intensive care

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BackgroundAneurysmal subarachnoid hemorrhage is a life-threatening disease requiring neurocritical care. Delayed cerebral ischemia is a well-known complication that contributes to unfavorable neurological outcomes. Cerebral vasospasm has been thought to be the main cause of delayed cerebral ischemia, and although several studies were able to decrease cerebral vasospasm, none showed improved neurological outcomes. Our target is not cerebral vasospasm but improving neurological outcomes. The purpose of this review is to discuss what intensivists should know and can do to improve clinical outcomes in subarachnoid hemorrhage patients.Main body of the abstractDelayed cerebral ischemia is thought to be due to not only vasospasm but also multifactorial mechanisms. Additionally, the concept of early brain injury, which occurs within the first 72 h after the hemorrhage, has become an important concern. Increasing sympathetic activity after the hemorrhage is associated with cardiopulmonary complications and poor outcomes. Serum lactate measurement may be a valuable marker reflecting the severity of sympathetic activity. The transpulmonary thermodilution method will bring about an advanced understanding of hemodynamic management. Fever is a well-recognized symptom and targeted temperature management is an anticipated intervention. To avoid hyperglycemia and hypoglycemia, performing moderate glucose control and minimizing glucose variability are important concepts in glycemic management, but the optimal target range remains unknown. Dysnatremia seems to be associated with negative outcomes. It is not clear yet that maintaining normonatremia actively improves neurological outcomes. Optimal duration of intensive care management has not been determined.Short conclusionAlthough we have an advanced understanding of the pathophysiology and clinical characteristics of subarachnoid hemorrhage, there are many controversies in the intensive care unit management of subarachnoid hemorrhage. With an awareness of not only delayed cerebral ischemia but also early brain injury, more attention should be given to various aspects to improve neurological outcomes.

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Section: Reviewsupporting

confidence: 90%

Aneurysmal subarachnoid hemorrhage: intensive care for improving neurological outcome

Okazaki

Kuroda

2018

j intensive care

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“…Hyponatremia itself can be a cause of cerebral edema, which can lead to cerebrovascular irritation, and it has been shown that declining sodium levels served as an early biomarker of impending vasospasm. 10,29,30 Leukocytosis has also been previously shown to be a biomarker for vasospasm, perhaps as a result of sympathetic activation caused by bleed severity and cerebrovascular agitation. Moreover, leukocytosis represents underlying inflammatory processes, consistent with the consideration of vasospasm and DCI as characteristically inflammatory events.…”

Section: Discussionmentioning

confidence: 99%

Cerebral vasospasm following arteriovenous malformation rupture: a population-based cross-sectional study

Dicpinigaitis

Feldstein

Shapiro

et al. 2022

Neurosurgical Focus

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OBJECTIVE Studies examining the risk factors and clinical outcomes of arterial vasospasm secondary to cerebral arteriovenous malformation (cAVM) rupture are scarce in the literature. The authors used a population-based national registry to investigate this largely unexamined clinical entity. METHODS Admissions for adult patients with cAVM ruptures were identified in the National Inpatient Sample during the period from 2015 to 2019. Complex samples multivariable logistic regression and chi-square automatic interaction detection (CHAID) decision tree analyses were performed to identify significant associations between clinical covariates and the development of vasospasm, and a cAVM–vasospasm predictive model (cAVM-VPM) was generated based on the effect sizes of these parameters. RESULTS Among 7215 cAVM patients identified, 935 developed vasospasm, corresponding to an incidence rate of 13.0%; 110 of these patients (11.8%) subsequently progressed to delayed cerebral ischemia (DCI). Multivariable adjusted modeling identified the following baseline clinical covariates: decreasing age by decade (adjusted odds ratio [aOR] 0.87, 95% CI 0.83–0.92; p < 0.001), female sex (aOR 1.68, 95% CI 1.45–1.95; p < 0.001), admission Glasgow Coma Scale score < 9 (aOR 1.34, 95% CI 1.01–1.79; p = 0.045), intraventricular hemorrhage (aOR 1.87, 95% CI 1.17–2.98; p = 0.009), hypertension (aOR 1.77, 95% CI 1.50–2.08; p < 0.001), obesity (aOR 0.68, 95% CI 0.55–0.84; p < 0.001), congestive heart failure (aOR 1.34, 95% CI 1.01–1.78; p = 0.043), tobacco smoking (aOR 1.48, 95% CI 1.23–1.78; p < 0.019), and hospitalization events (leukocytosis [aOR 1.64, 95% CI 1.32–2.04; p < 0.001], hyponatremia [aOR 1.66, 95% CI 1.39–1.98; p < 0.001], and acute hypotension [aOR 1.67, 95% CI 1.31–2.11; p < 0.001]) independently associated with the development of vasospasm. Intraparenchymal and subarachnoid hemorrhage were not associated with the development of vasospasm following multivariable adjustment. Among significant associations, a CHAID decision tree algorithm identified age 50–59 years (parent node), hyponatremia, and leukocytosis as important determinants of vasospasm development. The cAVM-VPM achieved an area under the curve of 0.65 (sensitivity 0.70, specificity 0.53). Progression to DCI, but not vasospasm alone, was independently associated with in-hospital mortality (aOR 2.35, 95% CI 1.29–4.31; p = 0.016) and lower likelihood of routine discharge (aOR 0.62, 95% CI 0.41–0.96; p = 0.031). CONCLUSIONS This large-scale assessment of vasospasm in cAVM identifies common clinical risk factors and establishes progression to DCI as a predictor of poor neurological outcomes.

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“…They have been shown to have longer hospital stays, as much as double the length of stay as patients who do not develop hyponatremia [13 ■■ ]. One study found that a decrease in serum sodium levels occurred 1 day prior to symptomatic vaso-spasm, which could assist in identifying patients at risk of developing this complication [14]. The location of the aneurysm has no relationship to the development or cause of hyponatremia [15].…”

Section: Sodium Homeostasismentioning

confidence: 99%

Fluid management concepts for severe neurological illness

Heifets

Tanaka²,

Burbridge³

2018

Current Opinion in Anaesthesiology

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As the possibility grows closer that we can monitor the physiological parameters with direct relevance for neurological outcomes and the various complications associated with neurocritical illness, we may finally move away from static therapy recommendations, and toward individualized, precise therapy. Although we believe therapy should ultimately be individualized rather than standardized, it is clear that the monitoring tools and analytical methods used ought to be standardized to facilitate appropriately powered, prospective clinical outcome trials.

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Decreased serum sodium levels predict symptomatic vasospasm in patients with subarachnoid hemorrhage

Cited by 24 publications

References 35 publications

Aneurysmal subarachnoid hemorrhage: intensive care for improving neurological outcome

Aneurysmal subarachnoid hemorrhage: intensive care for improving neurological outcome

Cerebral vasospasm following arteriovenous malformation rupture: a population-based cross-sectional study

Fluid management concepts for severe neurological illness

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