Significance Of The Serum Sodium And Its Fluctuation In Traumatic Brain Injury

Objective: Our study has two main objectives.The first is to investigate the relationship between sodium fluctuation and poor outcome in TBI patients,and to examine if their Glasgow Coma Scale(GCS)score on admission is correlated with this fluctuation.The second objective is to examine the relationship between serum sodium concentrations and ICP in a subgroup of patients who have undergone ICP monitoring implantation.Methods: We retrospectively reviewed all patients who had a diagnosis of TBI admitted to the Department of Neurosurgery at Renji Hospital between April 2016 and January 2019.The patients’ clinical data were collected from medical records and serum sodium values were collected at the time of admission(Day 0)and 6:00 am after admission on Days 1-10.We created several serum sodium fluctuation measures and subsequently analyzed the relationship between these measures and patient’s outcome.The correlation between serum sodium levels and GCS on admission was analyzed using linear regression and Spearman’s rank correlation coefficient.The correlation between serum sodium levels and corresponding ICP was analyzed using linear regression and Pearson correlation coefficient.Results:(1)A total of 326 patients met the inclusion criteria and were included in our study.Among which,58 patients had a poor outcome post TBI whereas 268 patients had a good outcome.Of these,107 patients underwent ICP monitoring probe implantation.(2)In patients with TBI,the serum sodium concentration in GCS 3-8 group and poor outcome group was significantly higher than that in GCS 9-15 group and good outcome group,the difference was statistically significant.(3)Sodium fluctuation measures after Day 1 and sodium fluctuation measures in the 10 days after admission were found to be independent predictors of poor outcome.(4)There was a linear correlation between the serum sodium fluctuation and GCS on admission,which was negative correlation.(5)There was a linear correlation between serum sodium concentration and ICP in patients with TBI.Conclusions:(1)There was a linear correlation between the serum sodium fluctuation and GCS on admission,the serum sodium fluctuation can reflect the severity of TBI.(2)Serum sodium fluctuation was found to be independent predictor of poor outcome,which may play a role in clinical outcome after TBI.(3)There was a linear correlation between serum sodium concentration and ICP in patients with TBI.