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Wang X, Li X, Sun J, Wang M, Lang W, Xu X. Relationship between sodium level and in-hospital mortality in traumatic brain injury patients of MIMIC IV database. Front Neurol 2024; 15:1349710. [PMID: 38562424 PMCID: PMC10982354 DOI: 10.3389/fneur.2024.1349710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background An association between prognosis and high sodium levels in Traumatic Brain Injury (TBI) patients in Intensive Care Units (ICUs) has been noted, but limited research exists on the ideal sodium level in these patients or the impact on early mortality, using the MIMIC-IV database. Methods A retrospective survey was conducted on TBI patients from the MIMIC-IV database. Patients were divided into two categories based on their highest serum sodium level within 24 h of admission exceeding 145 mmol/L: those with hypernatremia, and those with moderate-to-low sodium levels. Collected covariates encompasses demographic, clinical, laboratory, and intervention variables. A multivariate logistic regression model was implemented to forecast in-hospital mortality. Results The study included 1749 TBI patients, with 209 (11.5%) experiencing in-hospital deaths. A non-linear test exposed an L-shaped correlation between sodium level and in-hospital mortality, with mortality rates increasing after a turning point at 144.1 mmol/L. Compared to the moderate-to-low group's 9.3% mortality rate, the hypernatremia group had a significantly higher mortality rate of 25.3% (crude odds ratio = 3.32, 95% confidence interval: 2.37 ~ 4.64, p < 0.001). After adjusting for all covariates, the hypernatremia group continued to show a significant correlation with higher mortality risk (adjusted odds ratio = 2.19, 95% confidence interval: 1.38 ~ 3.47, p = 0.001). This trend remained consistent regardless of the analyses stratification. Conclusion The study reveals an L-shaped relationship between sodium levels and in-hospital deaths, with a pivotal point at 144.1 mmol/L. TBI patients displaying hypernatremia were independently linked to higher in-hospital mortality, underlining the need for further studies into targeted management of sodium levels in these patients.
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Affiliation(s)
- Xiaoliang Wang
- Neurology Department of Qingdao Municipal Hospital, Nanjing Medical University, Qingdao, Shandong Province, China
| | - Xin Li
- Neurology Department of Qingdao Municipal Hospital, Nanjing Medical University, Qingdao, Shandong Province, China
| | - Jiahao Sun
- Neurology Department of Qingdao Municipal Hospital, Nanjing Medical University, Qingdao, Shandong Province, China
| | - Mengmeng Wang
- Neurology Department of Qingdao Municipal Hospital, Nanjing Medical University, Qingdao, Shandong Province, China
| | - Wenjuan Lang
- Neurology Department of Qingdao Municipal Hospital, Nanjing Medical University, Qingdao, Shandong Province, China
| | - Xin Xu
- Neurology Department of Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Wu H, Li X, Zhao L, Yuan J, Xing Y, Bai M, Sun S. Risk factors for mortality in brain injury patients who have severe hypernatremia and received continuous venovenous hemofiltration. Heliyon 2023; 9:e21792. [PMID: 38027977 PMCID: PMC10663868 DOI: 10.1016/j.heliyon.2023.e21792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objectives The mortality rate for people with brain injuries is increased when hypernatremia is present. Patients with severe hypernatremia, who have a significant short-term mortality rate, were shown to benefit from continuous venovenous hemofiltration (CVVH), which has been indicated to be successful. Exploring the risk factors for short-term mortality in brain injury patients who underwent CVVH and had severe hypernatremia was the aim of the current study. Materials and methods Retrospective screening was performed on patients with brain injuries who underwent CVVH at Xijing Hospital between 1 December 2010 and 31 December 2021 and who have a diagnosis of severe hypernatremia. The outcomes included 28-day patient mortality and hospital stay duration. The patient survival rate was examined using the Kaplan-Meier survival curve. To determine the risk factors for short-term death for patients, univariate and multivariate Cox regression analysis models were used. Results Our current study included a total of 83 individuals. The included patients had a median age of 49 (IQR 35-59) years. Of the included patients, 58 patients (69.9 %) died within 28 days. The median length of hospital stay for the patient was 13 (IQR 7-21) days. The APACHE II score, SOFA score, GCS, PLT count, INR, stroke, mechanical ventilation, and vasopressor reliance were related to 28-day mortality according to the univariate Cox analysis. INR (HR = 1.004, 95 % Cl: 1.001-1.006, P = 0.008), stroke (HR = 1.971, 95 % Cl: 1.031-3.768, P = 0.04), mechanical ventilation (HR = 3.948, 95 % Cl: 1.090-14.294, P = 0.036), and vasopressor dependency (HR = 2.262, 95 % Cl: 1.099-4.655, P = 0.027) were independently associated with the risk of 28-day death rates, according to multivariate Cox regression analysis. Conclusions Brain injuries who have severe hypernatremia requires CVVH, which has high short-term patient mortality. Mechanical ventilation, INR increase, stroke, and vasopressor dependence are independently associated with increased patient mortality risk.
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Affiliation(s)
- Hao Wu
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
- Xi'an Medical University, Xi 'an, Shanxi, China
| | - Xiayin Li
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
- Xi'an Medical University, Xi 'an, Shanxi, China
| | - Lijuan Zhao
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
| | - Jinguo Yuan
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
| | - Yan Xing
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
| | - Ming Bai
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
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