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Critical Care

, 13:R110

First Online: 07 July 2009Received: 31 March 2009Accepted: 07 July 2009


IntroductionThe study was aimed at verifying whether the occurrence of hypernatremia during the intensive care unit ICU stay increases the risk of death in patients with severe traumatic brain injury TBI. We performed a retrospective study on a prospectively collected database including all patients consecutively admitted over a 3-year period with a diagnosis of TBI post-resuscitation Glasgow Coma Score ≤ 8 to a general-neurotrauma ICU of a university hospital, providing critical care services in a catchment area of about 1,200,000 inhabitants.

MethodsDemographic, clinical, and ICU laboratory data were prospectively collected; serum sodium was assessed an average of three times per day. Hypernatremia was defined as two daily values of serum sodium above 145 mmol-l. The major outcome was death in the ICU after 14 days. Cox proportional-hazards regression models were used, with time-dependent variates designed to reflect exposure over time during the ICU stay: hypernatremia, desmopressin acetate DDAVP administration as a surrogate marker for the presence of central diabetes insipidus, and urinary output. The same models were adjusted for potential confounding factors.

ResultsWe included in the study 130 TBI patients mean age 52 years standard deviation 23; males 74%; median Glasgow Coma Score 3 range 3 to 8; mean Simplified Acute Physiology Score II 50 standard deviation 15; all were mechanically ventilated; 35 26.9% died within 14 days after ICU admission. Hypernatremia was detected in 51.5% of the patients and in 15.9% of the 1,103 patient-day ICU follow-up. In most instances hypernatremia was mild mean 150 mmol-l, interquartile range 148 to 152. The occurrence of hypernatremia was highest P = 0.003 in patients with suspected central diabetes insipidus 25-130, 19.2%, a condition that was associated with increased severity of brain injury and ICU mortality. After adjustment for the baseline risk, the incidence of hypernatremia over the course of the ICU stay was significantly related with increased mortality hazard ratio 3.00 95% confidence interval: 1.34 to 6.51; P = 0.003. However, DDAVP use modified this relation P = 0.06, hypernatremia providing no additional prognostic information in the instances of suspected central diabetes insipidus.

ConclusionsMild hypernatremia is associated with an increased risk of death in patients with severe TBI. In a proportion of the patients the association between hypernatremia and death is accounted for by the presence of central diabetes insipidus.

AbbreviationsCDIcentral diabetes insipidus

CTcomputed tomography

DDAVPdesmopressin acetate

ICUintensive care unit

ICPintracranial pressure

IMPACTInternational Mission for Prognosis and Analysis of Clinical Trials in TBI


TBItraumatic brain injury.

Electronic supplementary materialThe online version of this article doi:10.1186-cc7953 contains supplementary material, which is available to authorized users.

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Autor: Umberto Maggiore - Edoardo Picetti - Elio Antonucci - Elisabetta Parenti - Giuseppe Regolisti - Mario Mergoni - Antonella V


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