Endocrine Response After Severe Subarachnoid Hemorrhage Related to Sodium and Blood Volume Regulation

Audibert, Gérard; Steinmann, G.; Talancé, Nicole de; Laurens, M. H.; Dao, Pierre; Baumann, A.; Longrois, Dan; Mertès, Paul-Michel

doi:10.1213/ane.0b013e31819a85ae

Cited by 66 publications

(45 citation statements)

References 43 publications

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“…The findings of our investigation are consistent with evidence in the literature linking sympathetic function with diverse systemic and multiorgan derangements, including hypertension [46], myocardial ischemia [47], congestive heart failure [48], cardiac tachyarrhythmias [49], sudden cardiac mortality [50], abnormal renal natriuresis [51], enhanced platelet aggregation [52] and impaired immune function [53]. Sympathetically mediated neurogenic cardiopulmonary complications have been related to adverse outcomes following SAH [54], and sympathetic activity has been connected to increased inflammation and enhanced thrombosis [7,8], the markers of which predict detrimental outcomes in patients with SAH [18,20].…”

Section: Discussionsupporting

confidence: 90%

Cerebrospinal Fluid Catecholamine Levels as Predictors of Outcome in Subarachnoid Hemorrhage

Moussouttas

Huynh

Khoury³

et al. 2012

Cerebrovasc Dis

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Objective: Subarachnoid hemorrhage (SAH) is associated with marked sympathetic activation at the time of ictus. The purpose of this study is to determine whether early central catecholamine levels measured from cerebrospinal fluid (CSF) relate to outcome in patients with SAH. Methods: Observational study of consecutive SAH grade 3–5 patients who underwent ventriculostomy placement, but did not undergo open craniotomy for aneurysm obliteration. CSF samples were obtained during the first 48 h following symptom onset and assayed for catecholamine levels. Statistical analyses were performed to determine whether the levels predicted mortality by day 15 or mortality/disability by day 30. Results: For the 102 patients included, mean age was 58, and 73% were female – 21% experienced day-15 mortality, and 32% experienced mortality/disability by day 30. Early mortality was related to Hunt-Hess (H/H) grade (p < 0.001), neurogenic cardiomyopathy (NC) (p = 0.003), cerebral infarction (p = 0.001), elevated intracranial pressure (ICP) (p = 0.029), epinephrine (EPI) level (p = 0.002) and norepinephrine/3,4-dihydroxyphenylglycol (NE/DHPG) ratio (p = 0.003). Mortality/disability was related to H/H grade (p < 0.001), NC (p = 0.018), infarction (p < 0.001), elevated ICP (p = 0.002), EPI (p = 0.004) and NE/DHPG (p = 0.014). Logistic regression identified age [OR 1.09 (95% CI 1.01–1.17)], H/H grade [9.52 (1.19–77)], infarction [10.87 (1.22–100)], ICP elevation [32.26 (2–500)], EPI [1.06 (1.01–1.10)], and (inversely) DHPG [0.99 (0.99–1.00)] as independent predictors of early mortality. For mortality/disability, H/H grade [OR 21.74 (95% CI 5.62–83)], ICP elevation [18.52 (1.93–166)], and EPI [1.05 (1.02–1.09)] emerged as independent predictors. Proportional-hazards analysis revealed age [HR 1.041 (95% CI 1.003–1.08)], H/H grade [6.9 (1.54–31.25)], NC [4.31 (1.5–12.35)], and EPI [1.032 (1.009–1.054)] independently predicted early mortality. Conclusions: CSF catecholamine levels are elevated in SAH patients who experience early mortality or disability. EPI may potentially serve as useful index of outcome in this population of patients with SAH.

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Section: Discussionsupporting

confidence: 90%

Cerebrospinal Fluid Catecholamine Levels as Predictors of Outcome in Subarachnoid Hemorrhage

Moussouttas

Huynh

Khoury³

et al. 2012

Cerebrovasc Dis

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“…In several uncontrolled studies, the development of volume contraction was found to be ameliorated by the administration of large amounts of fluids [17,19]. In another study, however, only hyponatremia but not decreased circulating blood volume was prevented by administration of large amounts of sodium and water, adapted to renal excretion [20]. The guidelines of the American Heart Association [21] recommend that volume contraction be treated with isotonic fluids (Class IIa, Level of Evidence B), and that ''administration of large volumes of hypotonic fluids should generally be avoided after SAH (Class I, Level of Evidence B)''.…”

Section: Discussionmentioning

confidence: 99%

Randomized, Double-Blind Trial of the Effect of Fluid Composition on Electrolyte, Acid–Base, and Fluid Homeostasis in Patients Early After Subarachnoid Hemorrhage

et al. 2012

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Background Hyper-and hyponatremia are frequently observed in patients after subarachnoidal hemorrhage, and are potentially related to worse outcome. We hypothesized that the fluid regimen in these patients is associated with distinct changes in serum electrolytes, acid-base disturbances, and fluid balance. Methods Thirty-six consecutive patients with SAH were randomized double-blinded to either normal saline and hydroxyethyl starch dissolved in normal saline (Voluven Ò ; saline) or balanced crystalloid and colloid solutions (Ringerfundin Ò and Tetraspan Ò ; balanced, n = 18, each) for 48 h. Laboratory samples and fluid balance were evaluated at baseline and at 24 and 48 h. Results Age [57 ± 13 years (mean ± SD; saline) vs. Conclusions Treatment with saline-based fluids resulted in a greater number of patients with hyperchloremia, hyperosmolality, and positive fluid balance >1,500 mL early after SAH, while administration of balanced solutions did not cause more frequent hyponatremia or hypo-osmolality. These results should be confirmed in larger studies.

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“…There have been four prospective studies in adult neurosurgical patients where extracellular volume (ECV) was assessed by the gold standard method of radioisotope dilution [12][13][14][15]. In these studies over 50% of the patients had decreased ECV, supporting a diagnosis of CSW rather than SIAD.…”

Section: Cerebral Salt-wasting Syndromementioning

confidence: 99%

“…In these studies over 50% of the patients had decreased ECV, supporting a diagnosis of CSW rather than SIAD. In one study by Audibert et al, the development of hyponatremia was prevented in 19 patients with SAH by the prophylactic administration of 0.9% sodium chloride, yet 53% had decreased ECV, demonstrating that CSW can be common in neurosurgical patients and that hyponatremia is not a necessary feature [15]. Similar prospective studies with ECV measurements have not been conducted in children, but retrospective studies in children with CNS disease suggest that CSW may be as common as SIAD [16].…”

Section: Cerebral Salt-wasting Syndromementioning

confidence: 99%

Syndrome of inappropriate antidiuresis and cerebral salt wasting syndrome: are they different and does it matter?

Moritz

2012

Pediatr Nephrol

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Endocrine Response After Severe Subarachnoid Hemorrhage Related to Sodium and Blood Volume Regulation

Cited by 66 publications

References 43 publications

Cerebrospinal Fluid Catecholamine Levels as Predictors of Outcome in Subarachnoid Hemorrhage

Cerebrospinal Fluid Catecholamine Levels as Predictors of Outcome in Subarachnoid Hemorrhage

Randomized, Double-Blind Trial of the Effect of Fluid Composition on Electrolyte, Acid–Base, and Fluid Homeostasis in Patients Early After Subarachnoid Hemorrhage

Syndrome of inappropriate antidiuresis and cerebral salt wasting syndrome: are they different and does it matter?

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