Traumatic Brain Injury, Electrolyte Levels, and Associated Outcomes: A Systematic Review

Ngatuvai, Micah; Martinez, Brian; Sauder, Matthew; Beeton, George; Andrade, Ryan; Maka, Piueti; Smith, Chadwick; Kornblith, Lucy Z.; Elkbuli, Adel

doi:10.1016/j.jss.2023.03.029

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…We tested the prognostic value of initial laboratory blood tests as a risk factor for mortality in patients with aSAH requiring MV after adjustment for other confounding variables such as disease severity, therapy, and radiologic findings. Interestingly, we found initial glucose and ionized calcium levels independently predicted survival in these patients, which were in accordance with prior literature emphasizing the prognostic role of these indicators in patients with other neurological diseases, such as spontaneous intracerebral hemorrhage ( 20 , 21 ) and traumatic brain injury ( 22 , 23 ), and a broader spectrum of critical ill patients including cardiac and septic causes ( 24 - 27 ). These findings may provide useful information for better clinical decision-making by both clinicians and families.…”

Section: Discussionsupporting

confidence: 91%

Prognostic value of initial routine laboratory blood tests in patients with aneurysmal subarachnoid hemorrhage requiring mechanical ventilation: a retrospective cohort study

Ren,

Zhang,

Liu

et al. 2023

J Thorac Dis

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Background Aneurysmal subarachnoid hemorrhage (aSAH) necessitating mechanical ventilation (MV) presents a serious challenge for intensivists. Laboratory blood tests reflect individual physiological and biochemical states, and provide a useful tool for identifying patients with critical condition and stratifying risk levels of death. This study aimed to determine the prognostic role of initial routine laboratory blood tests in these patients. Methods This retrospective cohort study included 190 aSAH patients requiring MV in the neurosurgical intensive care unit from December 2019 to March 2022. Follow-up evaluation was performed in May 2022 via routine outpatient appointment or telephone interview. The primary outcomes were death occurring within 7 days after discharge (short-term mortality) or reported at time of follow-up (long-term mortality). Clinico-demographic and radiological characteristics, initial routine laboratory blood tests (e.g., metabolic panels and arterial blood gas analysis), and treatment were analyzed and compared in relation to mortality. Multivariable logistic and Cox regression analyses, with adjustment of other clinical predictors, were performed to determine independent laboratory test predictors for short- and long-term mortality, respectively. Results The patients had a median age of 62 years, with a median World Federation of Neurosurgical Societies grade (WFNS) score of 5 and a median modified Fisher grade (mFisher) score of 4. The short- and long-term mortality of this cohort were 60.5% and 65.3%, respectively. Compared with survivors, non-survivors had more severe disease upon admission based on neurological status and imaging features and a shorter disease course, and were more likely to receive conservative treatment. Initial ionized calcium was found to be independently associate with both short-term [adjusted odds ratio (OR): 0.92; 95% confidence interval (CI): 0.86 to 0.99; P=0.020] and long-term mortality [adjusted hazard ratio (HR): 0.95; 95% CI: 0.92 to 0.99; P=0.010], after adjusting for potential confounders. Moreover, the admission glucose level was found to be associated only with short-term mortality (adjusted OR: 1.19; 95% CI: 1.06 to 1.34; P=0.004). Conclusions Laboratory screening may provide a useful tool for the management of aSAH patients requiring MV in stratifying risk levels for mortality and for better clinical decision-making. Further study is needed to validate the effects of calcium supplementation and glucose-lowering therapy on the outcomes in this disease.

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Section: Discussionsupporting

confidence: 91%

Prognostic value of initial routine laboratory blood tests in patients with aneurysmal subarachnoid hemorrhage requiring mechanical ventilation: a retrospective cohort study

Ren,

Zhang,

Liu

et al. 2023

J Thorac Dis

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“…Specifically, patients in their research cohort presented with a more severe average Glasgow Coma Scale (GCS) score (11.1 compared to our cohort’s 6) and were of a younger median age (52 versus 34 years, respectively). Recent meta-analyses further bolster the conclusion that hypernatremia is associated with heightened mortality risk ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Relationship between sodium level and in-hospital mortality in traumatic brain injury patients of MIMIC IV database

Wang,

Li,

Sun

et al. 2024

Front. Neurol.

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BackgroundAn association between prognosis and high sodium levels in Traumatic Brain Injury (TBI) patients in Intensive Care Units (ICUs) has been noted, but limited research exists on the ideal sodium level in these patients or the impact on early mortality, using the MIMIC-IV database.MethodsA retrospective survey was conducted on TBI patients from the MIMIC-IV database. Patients were divided into two categories based on their highest serum sodium level within 24 h of admission exceeding 145 mmol/L: those with hypernatremia, and those with moderate-to-low sodium levels. Collected covariates encompasses demographic, clinical, laboratory, and intervention variables. A multivariate logistic regression model was implemented to forecast in-hospital mortality.ResultsThe study included 1749 TBI patients, with 209 (11.5%) experiencing in-hospital deaths. A non-linear test exposed an L-shaped correlation between sodium level and in-hospital mortality, with mortality rates increasing after a turning point at 144.1 mmol/L. Compared to the moderate-to-low group’s 9.3% mortality rate, the hypernatremia group had a significantly higher mortality rate of 25.3% (crude odds ratio = 3.32, 95% confidence interval: 2.37 ~ 4.64, p < 0.001). After adjusting for all covariates, the hypernatremia group continued to show a significant correlation with higher mortality risk (adjusted odds ratio = 2.19, 95% confidence interval: 1.38 ~ 3.47, p = 0.001). This trend remained consistent regardless of the analyses stratification.ConclusionThe study reveals an L-shaped relationship between sodium levels and in-hospital deaths, with a pivotal point at 144.1 mmol/L. TBI patients displaying hypernatremia were independently linked to higher in-hospital mortality, underlining the need for further studies into targeted management of sodium levels in these patients.

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Electrolyte Disorders: Causes, Diagnosis, and Initial Care—Part 2

Larson,

Rogers,

Feeken

et al. 2024

Air Medical Journal

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Traumatic Brain Injury, Electrolyte Levels, and Associated Outcomes: A Systematic Review

Cited by 4 publications

References 19 publications

Prognostic value of initial routine laboratory blood tests in patients with aneurysmal subarachnoid hemorrhage requiring mechanical ventilation: a retrospective cohort study

Prognostic value of initial routine laboratory blood tests in patients with aneurysmal subarachnoid hemorrhage requiring mechanical ventilation: a retrospective cohort study

Relationship between sodium level and in-hospital mortality in traumatic brain injury patients of MIMIC IV database

Electrolyte Disorders: Causes, Diagnosis, and Initial Care—Part 2

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