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Article Dans Une Revue Critical Care Année : 2023

Dysnatremia at ICU admission and functional outcome of cardiac arrest : insights from four randomised controlled trials

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Purpose : to evaluate the potential association between early dysnatremia and 6-month functional outcome after cardiac arrest. Methods : we pooled data from four randomised clinical trials in post-cardiac-arrest patients admitted to the ICU with coma after stable return of spontaneous circulation (ROSC). Admission natremia was categorised as normal (135–145 mmol/L), low, or high. We analysed associations between natremia category and Cerebral Performance Category (CPC) 1 or 2 at 6 months, with and without adjustment on the modified Cardiac Arrest Hospital Prognosis Score (mCAHP). Results : we included 1163 patients (581 from HYPERION, 352 from TTH48, 120 from COMACARE, and 110 from Xe-HYPOTHECA) with a mean age of 63 ± 13 years and a predominance of males (72.5%). A cardiac cause was identified in 63.6% of cases. Median time from collapse to ROSC was 20 [15–29] minutes. Overall, mean natremia on ICU admission was 137.5 ± 4.7 mmol/L; 211 (18.6%) and 31 (2.7%) patients had hyponatremia and hypernatremia, respectively. By univariate analysis, CPC 1 or 2 at 6 months was significantly less common in the group with hyponatremia (50/211 [24%] vs. 363/893 [41%]; P = 0.001); the mCAHP-adjusted odds ratio was 0.45 (95%CI 0.26–0.79, p = 0.005). The number of patients with hypernatremia was too small for a meaningful multivariable analysis. Conclusions : early hyponatremia was common in patients with ROSC after cardiac arrest and was associated with a poorer 6-month functional outcome. The mechanisms underlying this association remain to be elucidated in order to determine whether interventions targeting hyponatremia are worth investigating.
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hal-04596415 , version 1 (31-05-2024)

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Jean Baptiste Lascarrou, Cyrielle Ermel, Alain Cariou, Timo Laitio, Hans Kirkegaard, et al.. Dysnatremia at ICU admission and functional outcome of cardiac arrest : insights from four randomised controlled trials. Critical Care, 2023, 27 (1), pp.472. ⟨10.1186/s13054-023-04715-z⟩. ⟨hal-04596415⟩
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