Castro CVH, Jiménez CC

Language: Spanish
References: 17
Page: 172-176
PDF size: 679.64 Kb.

ABSTRACT

Introduction: traumatic brain injury (TBI) is a major public health problem with high incidence and mortality. Sodium plays a key role in osmotic balance and intracranial hypertension management. Dysnatremias are frequent and have been associated with mortality rates up to 86%, partly due to complications such as diabetes insipidus. Objective: to determine the relationship between 48-hour serum sodium variation and mortality in patients with TBI admitted to the intensive care unit. Material and methods: observational, descriptive, retrospective, and analytical study in patients with TBI admitted to the Intensive Care Unit of High Specialty Medical Unit, Specialty Hospital No. 1, Bajío National Medical Center, Mexican Social Security Institute. Serum sodium levels was recorded at admission and after 48 hours, as well as clinical outcome (survival or death). All consecutive cases between September 2023 and March 2025 was included. Statistical analysis will be performed using SPSS v25. Results: a total of 95 patients with severe TBI were included (mean age 40.9 years, 70.3% male), with an overall survival of 89% and hospital mortality of 11%. The 48-hour sodium delta was higher in non-survivors (7.5 vs 2.67 mEq/L; p = 0.02), with an AUC of 0.72 and a cutoff of 7.0 mEq/L (sensitivity 70%, specificity 75.3%). A delta ≥ 6.0 mEq/L was associated with acute kidney injury (AUC 0.72; sensitivity 83.3%, specificity 67.4%). Non-survivors had greater use of hypertonic solutions, more acute kidney injury (AKI) cases, poorer oxygenation, and higher rates of hepatic failure and thrombocytopenia. They also showed worse scores in SOFA, APACHE II, and Marshall scales, and lower initial Glasgow scores. Neurological functional outcomes at 30 days were significantly better in survivors according to Rankin and GOSE scales. Conclusions: the 48-hour sodium delta was identified as an early dynamic biomarker associated with mortality and acute kidney injury in patients with severe TBI. Close monitoring and controlled correction of sodium may optimize management and improve survival and functional outcomes.

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