by Jean Baptiste
Lascarrou, Cyrielle Ermel, Alain Cariou, Timo Laitio, Hans Kirkegaard, Eldar
Søreide, Anders M. Grejs, Matti Reinikainen, Gwenhael Colin, Fabio Silvio
Taccone, Amélie Le Gouge and Markus B. Skrifvars
Critical Care volume 27,
Article number: 472 (2023) Published: 01
December 2023
Purpose
To evaluate the potential association between early
dysnatremia and 6-month functional outcome after cardiac arrest.
Methods
We pooled data from four randomised clinical trials in
post-cardiac-arrest patients admitted to the ICU with coma after stable return
of spontaneous circulation (ROSC). Admission natremia was categorised as normal
(135–145 mmol/L), low, or high. We analysed associations between natremia
category and Cerebral Performance Category (CPC) 1 or 2 at 6 months, with
and without adjustment on the modified Cardiac Arrest Hospital Prognosis Score
(mCAHP).
Results
We included 1163 patients (581 from HYPERION, 352 from
TTH48, 120 from COMACARE, and 110 from Xe-HYPOTHECA) with a mean age of
63 ± 13 years and a predominance of males (72.5%). A cardiac cause was
identified in 63.6% of cases. Median time from collapse to ROSC was 20 [15–29]
minutes. Overall, mean natremia on ICU admission was 137.5 ± 4.7 mmol/L;
211 (18.6%) and 31 (2.7%) patients had hyponatremia and hypernatremia,
respectively. By univariate analysis, CPC 1 or 2 at 6 months was significantly
less common in the group with hyponatremia (50/211 [24%] vs. 363/893
[41%]; P = 0.001); the mCAHP-adjusted odds ratio was 0.45 (95%CI
0.26–0.79, p = 0.005). The number of patients with hypernatremia was too
small for a meaningful multivariable analysis.
Conclusions
Early hyponatremia was common in patients with ROSC after
cardiac arrest and was associated with a poorer 6-month functional outcome. The
mechanisms underlying this association remain to be elucidated in order to
determine whether interventions targeting hyponatremia are worth investigating.
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