Key result
Patients with a minimum serum sodium level ≤128 mmol/L after low-grade aneurysmal subarachnoid hemorrhage had a significantly higher risk of endovascular treatment-needed vasospasm (OR 6.79).
Why the study?
Hyponatremia predicts symptomatic vasospasm after subarachnoid hemorrhage, but no guidelines recommend an absolute serum sodium value for prevention.
Does a minimum serum sodium level < 133 mmol/L predict endovascular treatment-needed vasospasm in patients with low-grade aneurysmal subarachnoid hemorrhage?
Cohort (n=216)
Yes
Does a minimum serum sodium level < 133 mmol/L predict endovascular treatment-needed vasospasm in patients with low-grade aneurysmal subarachnoid hemorrhage?
A minimum serum sodium level below 133 mmol/L during the first two weeks after low-grade aneurysmal subarachnoid hemorrhage is a significant predictor of vasospasm requiring endovascular treatment.
Answers are grounded in this paper and cite their sources.
MinNa ≤133 mmol/L was associated with etVS in low-grade SAH; hypothesis-generating for sodium targets, needing prospective trials before practice change.
Objective: Symptomatic vasospasm (SVS) affects the outcomes of patients with subarachnoid hemorrhage (SAH) and often requires endovascular treatment. Hyponatremia is a predictor of SVS; however, no guidelines have recommended an absolute serum sodium value for SVS prevention. This study aimed to identify factors that influence SVS in patients with low-grade SAH and determine a specific threshold of serum sodium level that predicts SVS. Methods: We conducted a multicenter, retrospective study of 216 patients with aneurysmal SAH grades I-III (World Federation of Neurological Societies scale). Patients were divided into the endovascular treatment-needed vasospasm (etVS) group (n = 29) and non-etVS group (n = 187). The minimum serum sodium level (minNa) was determined in the initial 2 weeks after SAH onset. Results: The minNa of the etVS group (median 132 mmol/L) was significantly lower compared to that of the non-etVS group (median 136 mmol/L) (p <0.001). The receiver operating characteristic curve revealed that a threshold minNa of 133 mmol/L predicted the development of etVS (sensitivity 0.797 and specificity 0.552), and the area under the curve was 0.703 (95% confidence interval [CI]: 0.591-0.815). The odds ratios for etVS in patients with a minNa ≤128 mmol/L and 129-132 mmol/L were 6.79 (95% CI: 2.24-20.51) and 2.96 (95% CI: 0.90-9.73), respectively, when compared to those with a minNa 133-136 mmol/L. Conclusion: Serum sodium levels were a predictor of etVS in patients with low-grade SAH. This is the first study to identify a threshold of serum sodium level for predicting etVS, aiding clinicians in setting a management goal for SVS prevention.
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Yamada et al. (2024) conducted a cohort in Low-grade aneurysmal subarachnoid hemorrhage (n=216). Minimum serum sodium level ≤128 mmol/L vs. Minimum serum sodium level 133-136 mmol/L was evaluated on Endovascular treatment-needed vasospasm (etVS) (OR 6.79, 95% CI 2.24-20.51). Patients with a minimum serum sodium level ≤128 mmol/L after low-grade aneurysmal subarachnoid hemorrhage had a significantly higher risk of endovascular treatment-needed vasospasm (OR 6.79).
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