Significance of fluctuations in serum sodium levels following aneurysmal subarachnoid hemorrhage: an exploratory analysis

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OBJECTIVE

Fluctuations in patient serum sodium levels are common after aneurysmal subarachnoid hemorrhage (aSAH), but their effect on patient outcome is not well described in the literature. The goal of this work was to better characterize the relationship between fluctuations in serum sodium levels, outcome, and the development of delayed cerebral ischemia (DCI) after aSAH.

METHODS

The authors performed a post hoc analysis of data from the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial. Patients had their serum sodium values recorded daily for 14 days post-aSAH. Average and average absolute daily differences in sodium levels were calculated for each patient based on 3 reference points: admission sodium levels, a normal sodium level (defined as 140 mmol/L), and the previous day’s sodium level. These variables were also calculated for the classic “vasospasm window” (days 3–12) post-aSAH. A stepwise logistic regression model, locally weighted scatterplot smoothing curves, and receiver operator characteristic curve analysis were used to evaluate the relationship between alterations in serum sodium levels and clinical outcome or the development of DCI after aSAH. Poor outcome was defined as a modified Rankin Scale (mRS) score of > 2 at 3 months.

RESULTS

The average daily difference in sodium values from baseline (p < 0.001), average daily difference from a normal sodium level (p < 0.001), average absolute daily difference from a normal sodium level (p = 0.015), and average absolute daily difference from the previous day’s sodium level (p = 0.017) were significant predictors of poor outcome in a stepwise multivariate regression model. There was a trend toward significance for average absolute daily difference from admission sodium levels during the vasospasm window as an independent predictor of DCI (p = 0.052). There was no difference in the predictive capacity for DCI when sodium fluctuations from post-aSAH days 1–14 were compared with those from the classic vasospasm window (days 3–12).

CONCLUSIONS

Fluctuations in serum sodium levels may play a role in clinical outcome and the development of DCI after aSAH. The timing of these fluctuations appears to have no significant effect on the development of DCI.

ABBREVIATIONS aSAH = aneurysmal subarachnoid hemorrhage; CONSCIOUS-1 = Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage; DCI = delayed cerebral ischemia; LOWESS = locally weighted scatterplot smoothing; mRS = modified Rankin Scale; WFNS = World Federation of Neurosurgical Societies.

Article Information

Correspondence Matthew E. Eagles: University of Calgary, AB, Canada. matthew.eagles@ucalgary.ca.

INCLUDE WHEN CITING Published online August 17, 2018; DOI: 10.3171/2018.3.JNS173068.

Disclosures Dr. Macdonald reports ownership of Edge Therapeutics, Inc. and receiving non–study-related clinical or research effort support from the Brain Aneurysm Foundation, Heart and Stroke Foundation of Canada, Canadian Institutes for Health Research, and Physicians Services Incorporated Foundation.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    LOWESS curve demonstrating the relationship between the proportion of patients who had a poor outcome (mRS score > 2 at 3 months) and their average daily change in serum sodium (mmol/L) from their baseline levels on admission.

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    LOWESS curve demonstrating the relationship between the proportion of patients who developed DCI and their average daily change in serum sodium (mmol/L) from their baseline levels on admission.

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