The Impact of Aneurysm Location on Incidence and Etiology of Hyponatremia Following Subarachnoid Hemorrhage
The Impact of Aneurysm Location on Incidence and Etiology of Hyponatremia Following Subarachnoid Hemorrhage
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DOI：
10.1016/j.wneu.2017.11.058
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发表时间：
2018-02-01
影响因子：
2
通讯作者：
Chin, Lawrence S.
中科院分区：
文献类型：
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作者：
Hoffman, Haydn;Ziechmann, Robert;Chin, Lawrence S.
背景：低钠血症是动脉瘤性蛛网膜下腔出血（aSAH）患者最常见的电解质异常。抗利尿激素分泌不当综合征（SIADH）和脑性盐消耗（CSW）是最常见的病因。破裂动脉瘤的位置是否与低钠血症的病因有关尚不清楚。我们试图确定 aSAH 后 SIADH 和 CSW 的发生率是否因动脉瘤位置而异。方法：对同一机构连续 335 名出现 aSAH 的患者进行回顾性分析。如果患者在出血后第 14 天之前出现低钠血症，则将其纳入。对电子健康记录进行了审查，以获取有关动脉瘤位置、治疗、低钠血症病因以及出院时改良 Rankin 量表评分的数据。结果：114 名患者符合纳入标准。共有 67 个（59%）前循环动脉瘤和 47 个（41%）后循环动脉瘤。在患者中，85 例 (75%) 因 SIADH 出现低钠血症，14 例 (12%) 患有 CSW，15 例 (13%) 不符合任一病因。与后循环动脉瘤 (75%) 相比，前循环动脉瘤 (90%) 中 SIADH 比 CSW 更常见。这一趋势趋于统计显着性，但并未达到显着性（P = 0.08）。更严重的 Hunt 和 Hess 分级与 CSW 而非 SIADH 的发生相关 (P = 0.002)。结论：在 aSAH 患者中，SIADH 比 CSW 更常见。与后循环动脉瘤相比，前循环动脉瘤可能与更高的 SIADH 发生率相关。
BACKGROUND: Hyponatremia is the most common electrolyte abnormality in patients with aneurysmal sub-arachnoid hemorrhage (aSAH). Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt wasting (CSW) are the most common etiologies. Whether or not the location of the ruptured aneurysm is associated with the etiology of hyponatremia is unknown. We sought to determine whether or not the incidence of SIADH and CSW after aSAH differed based on aneurysm location.METHODS: Retrospective analysis of 335 consecutive patients who presented with aSAH at a single institution was performed. Patients were included if they developed hyponatremia before postbleed day 14. Electronic health records were reviewed to obtain data regarding aneurysm location, treatment, etiology of hyponatremia, and modified Rankin Scale score at hospital discharge.RESULTS: Inclusion criteria were met by 114 patients. There were 67 (59%) anterior circulation aneurysms and 47 (41%) posterior circulation aneurysms. Of patients, 85 (75%) had hyponatremia owing to SIADH, 14 (12%) had CSW, and 15 (13%) did not fit either etiology. SIADH was more common than CSW in anterior circulation aneurysms (90%) compared with posterior circulation aneurysms (75%). This trended toward, but did not reach, statistical significance (P = 0.08). More severe Hunt and Hess grades were associated with the development of CSW rather than SIADH (P = 0.002).CONCLUSIONS: SIADH is much more common than CSW in patients with aSAH. Anterior circulation aneurysms may be associated with a higher rate of SIADH than posterior circulation aneurysms.