Introduction: Hyponatremia in nontraumatic intracerebral hemorrhage worsens intracranial hypertension leading to severely poor outcomes. Though, there remains controversy in regard to its associations, the potential benefit of correction, and its generalizability across diverse patient populations. This study evaluates the impact of hyponatremia on mortality, survival, and complication rates in nontraumatic ICH.
Methods: A retrospective cohort study using TriNetX database included 31,250 patients with nontraumatic ICH. Cohort A (hyponatremic, serum sodium ≤130 mmol/L) and Cohort B (normonatremic, serum sodium >130 mmol/L) resulted in 15,625 patients for each cohort after propensity score matching for confounding variables. Primary outcomes were in-hospital and 30-day mortality. Secondary outcomes were rates of seizure, tracheostomy, PEG insertion, pulmonary embolism (PE), and deep vein thrombosis (DVT). Statistical analysis included t-tests, chi-squared tests, Kaplan-Meier analysis, and log-rank tests, with significance set at p< 0.05.
Results: Hyponatremic patients had significantly higher 30-day (p < 0.001) and 365-day (p < 0.001) mortality rates. Seizure rates were elevated in the hyponatremic group at 30 days (p=0.002) and 365 days (p < 0.001). Tracheostomy (p < 0.001) and PEG insertion (p < 0.001) were more common as well. Hyponatremic patients also had higher thromboembolic event rates, including DVT within 30 days (p < 0.001) and at 365 days (p=0.003), and PE at 30 days (p=0.003). Craniotomy rates did not differ significantly (p=0.616). Kaplan-Meier analysis showed reduced survival in the hyponatremic group at both 30 days and 365 days (p < 0.001).
Conclusion : Hyponatremia is a significant and independent predictor of increased mortality and complications in nontraumatic ICH. Recognizing and managing hyponatremia in ICH may improve outcomes, but it often reflects associated underlying conditions such as liver disease or anemia. Further studies should explore the most common patient-specific factors affecting hyponatremia management in ICH.
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