Resident Houston Methodist Neurological Institute Houston, TX, US
Introduction: Hyponatremia is the most common electrolyte abnormality in traumatic brain injury (TBI) and is also an independent predictor of poor neurologic outcome. There remains controversy in regards to its associations with specific outcomes, the impact of correction, and the generalizability across diverse patient populations. This study evaluates the impact of hyponatremia in TBI patients as well as the overall morbidity and mortality.
Methods: A retrospective cohort study using ACS-NSQIP database TBI data included 2,487 patients with TBI who underwent surgery. 439 (17.6%) were identified as having hyponatremia (serum sodium < 135 mEq/L) and 2,048 (82.4%) were normonatremic (serum sodium ≥135 mEq/L). Statistical analysis included t-tests, chi-squared tests, and log-rank tests, with significance set at p< 0.05.
Results: Patients with hyponatremia had significantly longer operative times (1.7 ± 0.8 vs. 1.5 ± 0.9 hours, p < 0.001) and longer hospital stays (10.8 ± 7.4 vs. 9.5 ± 6.9 days, p < 0.001) compared to those with normal sodium levels. Hyponatremic patients had significantly higher rates of pneumonia (17.3% vs 12%, p=0.03), reintubation (9.3% vs 6.4%, p=0.027), failure to wean off ventilator >48 hours (28% vs 21.9%, p=0.006), cardiac arrest (3% vs 1.6%, p=0.046), intraoperative bleeding (19.1% vs 14.7%, p=0.02), septic shock (5% vs 2.3%, p=0.002). On univariate analysis, hyponatremia was associated with a higher incidence of 30-day morbidity (48.5% vs. 39.1%, OR 1.5, 95% CI 1.2-1.8, p < 0.001) and 30-day mortality (23.9% vs. 17.5%, OR 1.5, 95% CI 1.2-1.9 p = 0.002) compared to the normonatremic group.
Conclusion : Based on retrospective cohort data from the ACS-NSQIP database, we find that hyponatremia is associated with increased morbidity and mortality in TBI patients. Taking serum sodium status into account in this critically ill patient population may help guide clinical decision making and risk assessment.
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