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Indian Journal of Neurosurgery 2015; 04(02): 069-073
DOI: 10.1055/s-0035-1558961
Original Article
Neurological Surgeons' Society of India

Prognostic Significance of Hyponatremia Leukocytosis, Hypomagnesemia, and Fever after Aneurysmal Subarachnoid Hemorrhage

Vrsajkov Vladimir
1   Clinical Centre of Vojvodina, Emergency Centre, Novi Sad, Serbia
,
Jovanović Gordana
2   Department of Anesthesia and Intensive Care, Clinical Centre of Vojvodina, Novi Sad, Serbia
,
Galešev Marija
2   Department of Anesthesia and Intensive Care, Clinical Centre of Vojvodina, Novi Sad, Serbia
,
Uvelin Arsen
1   Clinical Centre of Vojvodina, Emergency Centre, Novi Sad, Serbia
,
Glišić Dunja
1   Clinical Centre of Vojvodina, Emergency Centre, Novi Sad, Serbia
,
Pantić-Vrsajkov Jelena
3   Health Care Centre “Novi Sad,” Novi Sad, Serbia
› Author Affiliations
Further Information

Publication History

09 April 2015

25 May 2015

Publication Date:
28 July 2015 (online)

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Abstract

Background Early identification of patients at an increased risk for delayed cerebral ischemia (DCI) and poor outcome could allow more aggressive therapy and influence better outcome. The aim of this study was to determine a predictive association of hyponatremia, hypomagnesemia, fever, and leukocytosis with DCI and poor outcome.

Patients and Methods We prospective enrolled 68 patients with subarachnoid hemorrhage (SAH) treated from March 2011 to May 2013. Serum levels of sodium, magnesium, and leukocyte count were determined at least once a day during the first 10 days after SAH. All patients underwent noncontrast computed tomography (CT) scan 9 ± 2 days after SAH. DCI was defined as one or more of the next parameters: a new focal neurological deficit, decline for two or more points on the modified Glasgow Coma Scale or a new hypodensity on CT scan. The outcome was assessed after 6 months using the extended Glasgow Outcome scale.

Results Overall, 48% of the patients recruited had DCI. Ramachandraiah logistic regression model showed significant impact of hyponatremia (p = 0.036; odds ratio [OR] = 4.08; 95% confidence interval [CI] = 1.09–15.26) on DCI and poor outcome (p = 0.034; OR = 5.11; 95% CI = 1.13–23.14). We obtained strong correlation of leukocytosis (p = 0.013) with DCI and poor outcome (p = 0.016). Association of noninfectious fever and hypomagnesemia with DCI existed, but it was not significant enough.

Conclusion Our results confirmed the association of hyponatremia and leukocytosis with greater risk of developing DCI and poor clinical outcome.

Keywords

subarachnoid hemorrhage - cerebral ischemia - Glasgow outcome scale - Hyponatremia - magnesium

Note

This article contains original unpublished work, not being submitted for publication elsewhere. Submission of the article has been approved by the authorities from University hospital and Clinical center Novi Sad, Serbia. The authors declare that there is no conflict of interests regarding the publication of this article. This is a joint statement of all the listed authors.


 

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