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2. Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Author

Joseph Merola, Nitin Mukerji, Emily Hall, Caroline Scott, Nicole Robin, Ashwin Kumaria, Midhun Mohan, David Holmes, David O'Brien, Sophie Hawkins, Catrin Sohrabi, Jack Cope, Josephine Jung, Mai Shehab, Huan Wee Chan, Menaka Paranathala, Milo Hollingworth, Setthasorn Zhi Yang Ooi, Ian Anderson, Charlotte Freer-Smith, Samir Matloob, Syed Zaidi, Harshal Ingale, Mehdi Khan, Nathan McSorley, Kamal Yakoub, Shaily Mehta, Rachel Walters, Keng Siang Lee, Mustafa El Sheikh, James J M Loan, Khadija Meghrawi, Qi Zhuang Siah, Hazel Sanghvi, Hari Pai, Steven Tominey, Kirun Baweja, Thomas J G Chambers, Mark Haley, Simran S Kundu, H Y Josephine Tang, Anthony N Wiggins, Sofia Weiss Goitiandia, Adam Lyons, Harry Kyriacou, Olivia Baker, Jonathan Armitage Johnson, Jaclyn Croyle, Conor McCandless, Flavia Dumitrascu, Kassandra Gressmann, Mario Teo, Nicholas Rees, Taslima Mona, Wail Mohammed, Eoin Minnock, Simran Kundu, David Grufferty, Harsha Daswani, Joel Rajesh, Oleksandra Kaskun, Temidayo Osunronbi, Arina Toma, Chinmay Tijare, Reddin Ahmad, Sen Yin Melina Kam, Stuart Stokes, Yanish Poolovadoo, Jordan Baker, Amar Naqash Siddique, Lara Othman, Venetia Giannakaki, Harry Carr, Callum Allison, James T Hughes, Alex Boukas, Catherine Lamb, Mark Jernej Zorman, Rotimi Babajide Latinwo, Sanskrithi Sravanam, Susan Isabel Honeyman, Devika Rajashekar, Bhumi Mehta, Lily McLean, Taufiq Khan, Neel Vyas, Anushka John, Dominic Thomas, Mehak Kakwani, Vinson Wai-Shun Chan, Arif Hanafi Bin Jalal, Mohamed Rashad Ramali, Praoparn Asanitthong, Yu Zhi Phuah, Omar Kouli, Laurence Johann Glancz, Giovanna Bettoli, Tom Cummins, Joseph Frantzias, Aisha Abubakar Mohamed, Hadis Reyhani, Jagbir Kaur Sall, Ruchika Vyas, Josephine Tang, Laith Osama Hashim Sinan, Raeesah Maqsood, Siddharth Kotikalapudi, Debayan Dasgupta, Ahsan Ali Taqvi, Charles Southey, Alysha Thompson, Harry Senior, Niamh Hardcastle, James Loan, Jodi Chiu, Katie Birt, Sanjay Govind Nair, Tom Grundy, Navleen Rooprai, Heather Radcliffe, Maram Nabahin, Saranya Siva, Sophia Mohammed, Luke Galloway, Lauren Sells, Sarah Ferbrache Namono, Aastha Agarwal, Alexander Lea, Jordan Russell, Katherine Denham, Anam Anzak, Ngawang Dheden, Sloni Arora, Tiffany Ye Tze Shan, Diyanah Merican, Hei Yi Vivian Pak, Wen Li Chia, Samuel Hall, Pavan Kaur Marwaha, Kiran Robbin, Alan M George, Kate Foster, Parthik Patel, and Sarthak Bahl

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Background Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH.Methods We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression.Results 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia.Conclusions In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care.

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