AUTHOR=Qian Ao , Zheng Longyi , He Zeyuan , Zhou Jing , Tang Shuang , Xing Wenli 

TITLE=Predictive value of hyponatremia for short-term mortality in supratentorial spontaneous intracerebral hemorrhage: a single center study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1301197

DOI=10.3389/fneur.2024.1301197

ISSN=1664-2295

ABSTRACT=Background: Hyponatremia is a common electrolyte disturbance in patients with neurological disease, however, its predictive role for outcome in patients with supratentorial spontaneous intracerebral hemorrhage (sICH) is controversial. This study is aimed to explore the association between hyponatremia within 7 days after bleeding and 90-day mortality in patients with supratentorial sICH. Methods: A retrospective analysis was conducted at our institution. Patients with sICH meeting inclusion criteria were enrolled into this study. Multivariate regression analyses were performed to determine the predictive value of hyponatremia (serum sodium < 135 mmol/L) for 90-day mortality and functional outcome. Subgroup analysis was performed based on degree and duration of hyponatremia, and therapeutic strategies. Spearman correlation test was performed to explore the relationship between hyponatremia severity and duration with variables in multivariate regression model. Kaplan-Meier curve was depicted to reveal the relationship between hyponatremia and mortality. Receiver operating characteristic (ROC) curve was performed to show the diagnostic effect of minimum concentration of serum sodium (sodiummin) on 90-day mortality. Results: Total 960 patients were enrolled, containing 19.6% (188) patients with hyponatremia, and 26.0% (250) rate of 90-day mortality. The incidence of hyponatremia was roughly 2.5 times in non-survivor compared with survivor patients (34.8% vs. 14.2%). Multivariate regression analysis revealed that hyponatremia was the independent predictor of 90-day mortality (OR 2.763,) and adverse outcome (OR 3.579,). Subgroup analysis indicated increased trend of mortality-risk with both duration (more or less than 48h) and severity of hyponatremia (mild, moderate, and severe), and confirmed the predictive value of hyponatremia for mortality in patients undergoing surgical intervention (external ventricular drainage, craniotomy, and decompressive craniectomy; all p < 0.05). Spearman correlation test indicated no moderate or strong relationship between hyponatremia severity and duration with other variables in multivariate model (all |rs| < 0.4). ROC curve suggested the moderate diagnostic performance of sodiummin for mortality in both general patients and subgroups of therapeutic method (AUC from 0.6475 to 0.7384). Conclusion: Hyponatremia occurred in the first 7 days after bleeding is an independent predictor of 90-day morality and adverse outcome. Rigorous electrolyte scrutiny in patients treated surgically is required.