IMPACT OF HYPONATREMIA ON CLINICAL OUTCOMES, RECOVERY, AND MORTALITY IN STROKE PATIENTS
Main Article Content
Keywords
Hyponatremia, Stroke, Clinical Outcomes, Mortality, Recovery
Abstract
Background: Low sodium levels in the blood, known as Hyponatremia is a usual electrolyte ailment in stroke patients and may contribute to adverse clinical outcomes.
Objective: This study evaluates the impact of hyponatremia on functional recovery, hospital mortality, and hospital stay in stroke patients.
Methods: This multicentre prospective study was carried out at three medical universities from July to December 2024. A total of 300 stroke patients were registered using consecutive sampling. Hyponatremia was defined as serum sodium <135 mEq/L at admission. Clinical outcomes, including hospital stay, GCS, mRS, complications, and mortality, were compared between hyponatremic and normonatremic patients. Multivariate logistic regression identified independent mortality predictors.
Results: Hyponatremia was observed in 90 (30%) patients. Hyponatremic patients had significantly longer hospital stays (9.2 ± 3.1 vs. 6.8 ± 2.4 days, p<0.001), lower GCS at admission (10.9 ± 3.0 vs. 12.8 ± 2.6, p<0.001), and altered rates of ICU admission (26.7% vs. 14.3%, p=0.006). They also had increased in-hospital complications, including aspiration pneumonia (22.2% vs. 11.9%, p=0.02) and seizures (15.6% vs. 8.6%, p=0.05). In-hospital mortality was significantly increased in hyponatremic patients (15.6% vs. 5.7%, p=0.005). Hyponatremia independently predicted mortality (OR 2.98, p=0.01).
Conclusion: Hyponatremia in stroke patients is associated to prolonged hospitalization, increased ICU admissions, worse neurological outcomes, and higher mortality. Early identification and management of hyponatremia may improve clinical outcomes.
References
2. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2023 update: a report from the American Heart Association. Circulation. 2023;147(0):0. doi:10.1161/CIR.0000000000001123.
3. Upadhyay A, Jaber BL, Madias NE. Epidemiology of hyponatremia. Semin Nephrol. 2009;29(3):227–38. doi:10.1016/j.semnephrol.2009.03.004.
4. Hakim M, Hasan M. Hyponatremia as an independent predictor of mortality and functional outcome in stroke. Neurology. 2020;94(15 Suppl):4311. Available from: https://n.neurology.org/content/94/15_Supplement/4311
5. Aleksandrowicz M, Kozniewska E. Hyponatremia as a risk factor for microvascular spasm following subarachnoid hemorrhage. Exp Neurol. 2022;355:114126. doi:10.1016/j.expneurol.2022.114126.
6. Liamis G, Barkas F, Megapanou E, et al. Hyponatremia in acute stroke patients: pathophysiology, clinical significance, and management options. Eur Neurol. 2019;82(1-2):32–40. doi:10.1159/000504475.
7. Kalita J, Singh RK, Misra UK. Cerebral salt wasting is the most common cause of hyponatremia in stroke. J Stroke Cerebrovasc Dis. 2017;26(5):1026–32. doi:10.1016/j.jstrokecerebrovasdis.2016.12.011.
8. Chen Z, Jia Q, Liu C. Association of hyponatremia and risk of short- and long-term mortality in patients with stroke: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2019;28(6):1674–83. doi:10.1016/j.jstrokecerebrovasdis.2019.02.021.
9. Rodrigues B, Staff I, Fortunato G, McCullough LD. Hyponatremia in the prognosis of acute ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23(4):850–4. doi:10.1016/j.jstrokecerebrovasdis.2013.07.011.
10. Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064–89. doi:10.1161/STR.0b013e318296aeca.
11. Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant. 2014;29 Suppl 2:0. doi:10.1093/ndt/gfu040.
12. Hoorn EJ, Zietse R. Hyponatremia and mortality: how innocent is the bystander? Clin J Am Soc Nephrol. 2011;6(5):951–3. doi:10.2215/CJN.01210211.
13. Saleem S, Yousuf I, Gul A, Gupta S, Verma S. Hyponatremia in stroke. Ann Indian Acad Neurol. 2014;17(1):55–7. doi:10.4103/0972-2327.128554.
14. Palmer BF. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends Endocrinol Metab. 2003;14(4):182–7. doi:10.1016/s1043-2760(03)00048-1.
15. Giuliani C, Peri A. Effects of hyponatremia on the brain. J Clin Med. 2014;3(4):1163–77. doi:10.3390/jcm3041163.
16. Gankam Kengne F, Decaux G. Hyponatremia and the brain. Kidney Int Rep. 2018;3(1):24–35. doi:10.1016/j.ekir.2017.08.015.
17. He L, Guo ZN, Qu Y, Jin H. Hyponatremia is associated with post-thrombolysis hemorrhagic transformation and poor clinical outcome in ischemic stroke patients. Front Mol Neurosci. 2022;15:879863. doi:10.3389/fnmol.2022.879863.
18. Narayan S, Gowda M, Khalid MS. The study of hyponatremia in the prognosis of acute ischemic stroke. Int J Adv Med. 2019;6(4):0.
19. Soiza RL, Cumming K, Clark AB, et al. Hyponatremia predicts mortality after stroke. Int J Stroke. 2015;10 Suppl A100:50–5. doi:10.1111/ijs.12564.
20. Bei HZ, You SJ, Zheng D, et al. Prognostic role of hypochloremia in acute ischemic stroke patients. Acta Neurol Scand. 2017;136(6):672–9. doi:10.1111/ane.12785.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Umair Ali
Liaquat University of Medical and Health Sciences Jamshoro, Pakistan,
Email: umairshaikh51@yahoo.com
Alishan khowaja
Liaquat National Hospital and Medical College Karachi
Dr Twinkle Kumari
People's University of Medical and Health Sciences for Women Shaheed Benazirabad
Dr FNU Karishma
People's University of Medical and Health Sciences for Women Shaheed Benazirabad
Dr Ashok Kumar Lohano
Associate professor Medicine Medical unit 11 People University of Medical & Health Sciences for Women’s Shaheed Benazirabad
Munesh Kumar Nenwani
Liaquat University of Medical and Health Sciences Jamshoro
Amisha kumari
Ghulam Muhammad Mahar Medical College Sukkur
Dr Anjoo Bai
People's University of Medical and Health Sciences for Women Shaheed Benazirabad
Dheeraj kumar
Liaquat University of Medical and Health Sciences Jamshoro
Hansa Devi
Liaquat University of Medical and Health Sciences Jamshoro