Abstract
Introduction
Abnormalities of serum sodium are common after subarachnoid hemorrhage (SAH) and have been linked to poor outcome. This study analyzed whether abnormal serum sodium levels are associated with cardiac outcomes and mortality after subarachnoid hemorrhage (SAH).
Methods
In a prospective cohort study of SAH patients, the primary predictor variable was subjects' sodium level. Hypernatremia was defined as sodium >143 mmol/L and hyponatremia was <133 mmol/L. Cardiac troponin I (cTi) was measured and echocardiography was performed on three study days. Dichotomous outcome variables were cTi >1.0 μg/L, left-ventricular ejection fraction (LVEF) <50%, presence (vs absence) of regional wall motion abnormalities (RWMA) of the LV, pulmonary edema, and death. Additional analyses studied the degree of hypernatremia and sodium supplementation, and the temporal relationship between hypernatremia and cardiac outcomes.
Results
The study included 214 subjects. Forty-eight subjects (22%) were hypernatremic on at least one study day, and 45 (21%) were hyponatremic. After multivariate adjustment, hypernatremia was an independent predictor of LVEF <50% (OR 4.7, CI 1.3–16.2, p=0.015), elevated cTi (OR 3.7, CI 1.2–11.9, p=0.028), and pulmonary edema (OR 4.1 CI 1.4–1.5, p=0.008). It was not, however a statistically significant predictor of mortality (p=0.075).
Conclusion
In the acute period after SAH, hypernatremia is associated with adverse cardiac outcomes and death. SAH patients with hypernatremia should be monitored for evidence of cardiac dysfunction.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Schievink VI. Intracranial aneurysms. N Engl J Med 1997;336: 28–40.
Hasan D, Lindsay KW, Widjicks EF, et al. Effect of fludrocortisone acetate in patients with subarachnoid hemorrhage. Stroke 1989; 20:1156–1161.
Qureshi AI, Suri MF, Sung GY, et al. Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 2002;50:749–755; discussion 755-756.
Segatore M. Hyponatremia after aneurysmal subarachnoid hemorrhage. J Neurosci Nurs 1993;25:92–99.
Takaku A, Shindo K, Tanaka S, Mori T, Suzuki J. Fluid and electrolyte disturbances in patients with intracranial aneurysms. Surg Neurol 1979;11:349–356.
Burch GE, Meyers R, Abildskov, JA. A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation 1954; 9:719–723.
Andreoli A, di Pasquale G, Pinelli G, Grazi P, Tognetti F, Testa C. Subarachnoid hemorrhage: frequency and severity of cardiac arrhythmias. Stroke 1987;18:558–564.
Myers MG, Norris JW, Hachinski VC, Weingert ME, Sole MJ. Cardiac sequelae of acute stroke. Stroke 1982;13:838–842.
Zaroff J, Rordorf G, Newell JB, Ogilvy C, Levinson JR. Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities. Neurosurgery 1999;44:34–39; discussion 39-40.
Sommargren CE, Zaroff JG, Banki N, Drew BJ. Electrocardiographic repolarization abnormalities in subarachnoid hemorrhage. J Electrocardiol 2002;35(Suppl):257–262.
Rudehill A, Olsson GL, Sundqvist K, Gordon E. ECG abnormalities in patients with subarachnoid haemorrhage and intracranial tumours. J Neurol Neurosurg Psychiatry 1987;50: 1375–1381.
Deibert E, Barzilai B, Braverman AC, et al. Clinical significance of elevated troponin I levels in patients with nontraumatic subarachnoid hemorrhage. J Neurosurg 2003;98: 741–746.
Parekh N, Venkatesh B, Cross D, et al. Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol 2000;36:1328–1335.
Handlin LR, Kindred LH, Beauchamp GD, Vacek JL, Rowe SK. Reversible left ventricular dysfunction after subarachnoid hemorrhage. Am Heart J 1993;126:235–240.
Sakka SG, Huettemann E, Reinhart K. Acute left ventricular dysfunction and subarachnoid hemorrhage. J Neurosurg Anesthesiol 1999;11:209–213.
Zaroff JG, Rordorf GA, Ogilvy CS, Picard MH. Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neurally mediated cardiac injury. J Am Soc Echocardiogr 2000;13:774–779.
Hunt W, Hess R. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1967;28: 14–20.
Schiller N, Shah P, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358–367.
Palevsky PM. Hypernatremia. Semin Nephrol 1998;18:20–30.
Yoshimoto Y, Tanaka Y, Hoya K. Acute systemic inflammatory response syndrome in subarachnoid hemorrhage. Stroke 2001;32: 1989–1993.
Schuiling WJ, de Weerd AW, Dennesen PJ, Algra A, Rinkel GJ. The simplified acute physiology score to predict outcome in patients with subarachnoid hemorrhage. Neurosurgery 2005;57:230–236; discussion 230-236.
Claassen J, Vu A, Kreiter KT, et al. Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage. Crit Care Med 2004;32:832–838.
Maxwell GM. The effects of induced hypernatremia upon the general and coronary haemodynamics and metabolism in the intact animal. Cardiology 1968;52:259–266.
Origitano TC, Wascher TM, Reichman OH, Anderson DE. Sustained increased cerebral blood flow with prophylactic hypertensive hypervolemic hemodilution (“triple-H” therapy) after subarachnoid hemorrhage. Neurosurgery 1990;27:729–739; discussion 739-740.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fisher, L.A., Ko, N., Miss, J. et al. Hypernatremia predicts adverse cardiovascular and neurological outcomes after SAH. Neurocrit Care 5, 180–185 (2006). https://doi.org/10.1385/NCC:5:3:180
Issue Date:
DOI: https://doi.org/10.1385/NCC:5:3:180