Hypernatremia is associated with poor long-term neurological outcomes in out-of-hospital cardiac arrest survivors

Cho, Eun Joo; Lee, Min Sung; Kwon, Woon Yong; Shin, Jonghwan; Suh, Gil Joon; Jung, Young-Seok; Song, Won Ji; Yeo, Gyeongyeon; Jo, You Hwan

doi:10.1016/j.ajem.2022.06.014

Cited by 6 publications

(3 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Elevated osmolality has been associated with a poor prognosis in association with many conditions, such as heart failure and traumatic brain injury [ 10 , 11 , 12 ]. In a study investigating OHCA, the mean SOsm of patients with poor neurological outcomes was higher than that of patients with good neurological outcomes, which was consistent with our study (at 0 h, 303.5 vs. 297.3 milliosmoles (mOsm)/L; 24 h, 300.5 vs. 288.4 mOsm/L) [ 13 ]. In that study, the investigators speculated that blood–brain barrier breakdown after cardiac arrest causes sodium leakage from blood vessels into the interstitial space, ultimately aggravating cerebral edema in OHCA survivors [ 13 ].…”

Section: Discussionsupporting

confidence: 91%

“…In a study investigating OHCA, the mean SOsm of patients with poor neurological outcomes was higher than that of patients with good neurological outcomes, which was consistent with our study (at 0 h, 303.5 vs. 297.3 milliosmoles (mOsm)/L; 24 h, 300.5 vs. 288.4 mOsm/L) [ 13 ]. In that study, the investigators speculated that blood–brain barrier breakdown after cardiac arrest causes sodium leakage from blood vessels into the interstitial space, ultimately aggravating cerebral edema in OHCA survivors [ 13 ]. Although that study showed a relationship between SOsm and neurological outcomes within 24 h after ROSC, in the present study, this relationship persisted until 72 h; multivariate analysis indicated that only SOsm at T3 was associated with poor neurological outcomes.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

The Relationship between the Ratio of Urine Osmolality to Serum Osmolality and Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients

Ryu,

Lee,

Lee

et al. 2024

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

Background: Progressive ischemic brain injury after cardiac arrest can cause damage to the hypothalamic-pituitary axis, particularly the pituitary gland. This may impact serum osmolality (SOsm) and urine osmolality (UOsm) in patients who have experienced out-of-hospital cardiac arrest (OHCA). We assumed that a low ratio of UOsm to SOsm (USR) is related to poor outcomes among OHCA patients. Therefore, the present study was designed to evaluate the association between the USR within 72 h after the restoration of spontaneous circulation (ROSC) and 6-month neurological outcomes in OHCA patients. Methods: This prospective, observational study included OHCA patients with targeted temperature management at Chonnam National University Hospital in Gwangju, Korea, between January 2016 and December 2022. We collected SOsm and UOsm data at admission (T0) and 24 (T1), 48 (T2), and 72 h (T3) after ROSC. The primary outcome was a poor neurological outcome at 6 months defined by cerebral performance categories 3, 4, or 5. Results: This study included 319 patients. The mean UOsm and USRs at T0, T1, T2, and T3 of patients with poor outcomes were lower than those of patients with good outcomes. Multivariable analysis indicated that the USRs at T1 (odds ratio [OR], 0.363; 95% confidence interval [CI], 0.221–0.594), T2 (OR, 0.451; 95% CI, 0.268–0.761), and T3 (OR, 0.559; 95% CI, 0.357–0.875) were associated with a poor outcome. The areas under the receiver operating characteristic curves of USRs at T0, T1, T2, and T3 for predicting poor outcomes were 0.615 (95% CI, 0.559–0.669), 0.711 (95% CI, 0.658–0.760), 0.724 (95% CI, 0.671–0.772), and 0.751 (95% CI, 0.699–0.797), respectively. Conclusions: The USRs within 72 h of ROSC were associated with poor neurological outcomes at 6 months in OHCA patients.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

The Relationship between the Ratio of Urine Osmolality to Serum Osmolality and Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients

Ryu,

Lee,

Lee

et al. 2024

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…One of the few studies of natremia in patients comatose after cardiac arrest and ROSC had a large sample size of 5160 and found that survival with a favourable outcome after 1 month was 17.6%, 8.2%, and 5.7% in the groups with normal, low, and high natremia, respectively [ 25 ]. In another retrospective study, early hypernatremia was associated with a lower probability of a favourable CPC after 1 year (aOR for each 1 mmol/L increase, 1.13; 95%CI 1.04–1.23; p = 0.004 [ 26 ]). In unselected patients admitted to a cardiac ICU, both hyponatremia and hypernatremia on admission were associated with higher in-hospital and 5-year mortality rates, both before and after adjustment [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Dysnatremia at ICU admission and functional outcome of cardiac arrest: insights from four randomised controlled trials

Lascarrou,

Ermel,

Cariou

et al. 2023

Crit Care

View full text Add to dashboard Cite

Purpose To evaluate the potential association between early dysnatremia and 6-month functional outcome after cardiac arrest. Methods We pooled data from four randomised clinical trials in post-cardiac-arrest patients admitted to the ICU with coma after stable return of spontaneous circulation (ROSC). Admission natremia was categorised as normal (135–145 mmol/L), low, or high. We analysed associations between natremia category and Cerebral Performance Category (CPC) 1 or 2 at 6 months, with and without adjustment on the modified Cardiac Arrest Hospital Prognosis Score (mCAHP). Results We included 1163 patients (581 from HYPERION, 352 from TTH48, 120 from COMACARE, and 110 from Xe-HYPOTHECA) with a mean age of 63 ± 13 years and a predominance of males (72.5%). A cardiac cause was identified in 63.6% of cases. Median time from collapse to ROSC was 20 [15–29] minutes. Overall, mean natremia on ICU admission was 137.5 ± 4.7 mmol/L; 211 (18.6%) and 31 (2.7%) patients had hyponatremia and hypernatremia, respectively. By univariate analysis, CPC 1 or 2 at 6 months was significantly less common in the group with hyponatremia (50/211 [24%] vs. 363/893 [41%]; P = 0.001); the mCAHP-adjusted odds ratio was 0.45 (95%CI 0.26–0.79, p = 0.005). The number of patients with hypernatremia was too small for a meaningful multivariable analysis. Conclusions Early hyponatremia was common in patients with ROSC after cardiac arrest and was associated with a poorer 6-month functional outcome. The mechanisms underlying this association remain to be elucidated in order to determine whether interventions targeting hyponatremia are worth investigating. Registration ClinicalTrial.gov, NCT01994772, November 2013, 21.

show abstract

Association of admission serum sodium and outcomes following out-of-hospital cardiac arrest

Ye,

Cheung,

Lauder

et al. 2024

American Heart Journal

View full text Add to dashboard Cite

Hypernatremia is associated with poor long-term neurological outcomes in out-of-hospital cardiac arrest survivors

Cited by 6 publications

References 21 publications

The Relationship between the Ratio of Urine Osmolality to Serum Osmolality and Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients

The Relationship between the Ratio of Urine Osmolality to Serum Osmolality and Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients

Dysnatremia at ICU admission and functional outcome of cardiac arrest: insights from four randomised controlled trials

Association of admission serum sodium and outcomes following out-of-hospital cardiac arrest

Contact Info

Product

Resources

About