• Anatole Harrois, James R Anstey, Mathieu van der Jagt, Fabio S Taccone, Andrew A Udy, Giuseppe Citerio, Jacques Duranteau, Carole Ichai, Rafael Badenes, John R Prowle, Ari Ercole, Mauro Oddo, Antoine Schneider, Stefan Wolf, Raimund Helbok, David W Nelson, D Jamie Cooper, Rinaldo Bellomo, and TBI Collaborative.
• Intensive Care Unit, Royal Melbourne Hospital, Level 5, B Block, Parkville, VIC, 3050, Australia. harroisanatole@yahoo.fr.
• Neurocrit Care. 2021 Jun 1; 34 (3): 899-907.

Background/ObjectiveDysnatremia is common in severe traumatic brain injury (TBI) patients and may contribute to mortality. However, serum sodium variability has not been studied in TBI patients. We hypothesized that such variability would be independently associated with mortality.MethodsWe collected 6-hourly serum sodium levels for the first 7 days of ICU admission from 240 severe TBI patients in 14 neurotrauma ICUs in Europe and Australia. We evaluated the association between daily serum sodium standard deviation (dNaSD), an index of variability, and 28-day mortality.ResultsPatients were 46 ± 19 years of age with a median initial GCS of 6 [4-8]. Overall hospital mortality was 28%. Hypernatremia and hyponatremia occurred in 64% and 24% of patients, respectively. Over the first 7 days in ICU, serum sodium standard deviation was 2.8 [2.0-3.9] mmol/L. Maximum daily serum sodium standard deviation (dNaSD) occurred at a median of 2 [1-4] days after admission. There was a significant progressive decrease in dNaSD over the first 7 days (coefficient - 0.15 95% CI [- 0.18 to - 0.12], p < 0.001). After adjusting for baseline TBI severity, diabetes insipidus, the use of osmotherapy, the occurrence of hypernatremia, and hyponatremia and center, dNaSD was significantly independently associated with 28-day mortality (HR 1.27 95% CI (1.01-1.61), p = 0.048).ConclusionsOur study demonstrates that daily serum sodium variability is an independent predictor of 28-day mortality in severe TBI patients. Further prospective investigations are necessary to confirm the significance of sodium variability in larger cohorts of TBI patients and test whether attenuating such variability confers outcome benefits to such patients.

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