• Homeyra Labib, Maud A Tjerkstra, Bert A Coert, René Post, W Peter Vandertop, Dagmar Verbaan, and MüllerMarcella C AMCADepartment of Intensive Care, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands..
• Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands.
• Crit. Care Med. 2024 May 1; 52 (5): 752763752-763.

ObjectivesTo perform a detailed examination of sodium levels, hyponatremia and sodium fluctuations, and their association with delayed cerebral ischemia (DCI) and poor outcome after aneurysmal subarachnoid hemorrhage (aSAH).DesignAn observational cohort study from a prospective SAH Registry.SettingTertiary referral center focused on SAH treatment in the Amsterdam metropolitan area.PatientsA total of 964 adult patients with confirmed aSAH were included between 2011 and 2021.InterventionsNone.Measurements And Main ResultsA total of 277 (29%) developed DCI. Hyponatremia occurred significantly more often in DCI patients compared with no-DCI patients (77% vs. 48%). Sodium levels, hyponatremia, hypernatremia, and sodium fluctuations did not predict DCI. However, higher sodium levels were significantly associated with poor outcome in DCI patients (DCI onset -7, DCI +0, +1, +2, +4, +5, +8, +9 d), and in no-DCI patients (postbleed day 6-10 and 12-14). Also, hypernatremia and greater sodium fluctuations were significantly associated with poor outcome in both DCI and no-DCI patients.ConclusionsSodium levels, hyponatremia, and sodium fluctuations were not associated with the occurrence of DCI. However, higher sodium levels, hypernatremia, and greater sodium fluctuations were associated with poor outcome after aSAH irrespective of the presence of DCI. Therefore, sodium levels, even with mild changes in levels, warrant close attention.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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