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The relationship between cerebral salt wasting syndrome and clinical outcome in severe and moderate traumatic brain injury patient at Sanglah Hospital, Bali, Indonesia

  • Nyoman Golden ,
  • Jeffrey Ariesta Putra ,
  • Wayan Niryana ,
  • Putu Eka Mardhika ,

Abstract

Introduction: Intracranial and extracranial factors causing secondary Traumatic Brain Injury (TBI) are the primary targets for medical intervention and preventing brain damage. One of the extracranial factors that worsen the prognosis of TBI is Cerebral Salt Wasting (CSW) syndrome. There are only a few articles that report CSW in TBI patients, and no studies are describing the relationship between CSW and clinical outcome of head injury. This study aimed to determine the relationship between CSW and clinical outcome of TBI patients.

Methods: This was a prospective cohort study conducted from October 2018 to May 2019. Data collection was carried out in a surgical emergency and inpatient ward at Sanglah Hospital. The outcome was assessed using the Glasgow Outcome Scale (GOS) 3 months after head injury. The relationship between variables was analyzed and using Chi-square analysis. Data were analyzed using SPSS version 23 for Windows.

Results: Most of respondents are male (83.3%), severe head injury (73.3%), mild hyponatremia (90.0%), and negative fluid balance (100.0%) in CSW (+) group (Table 1). However, in CSW (-) group, most of respondents are male (70.0%), moderate head injury (85.0%), normal serum natrium (80.0%), and positive fluid balance (60.0%). CSW increased the risk of unfavorable outcomes, 5.7 times in moderate and severe head injuries (95% CI=1.8 – 18.4; p=< 0.001).

Conclusion: CSW syndrome increased the risk of unfavorable outcomes in moderate and severe traumatic brain injury patients.

References

  1. Palmer BF. Hyponatremia in a neurosurgical patient: syndrome of inappropriate antidiuretic hormone secretion versus cerebral salt wasting. Nephrol Dial Transplant. 2000; 15(2): 262 – 8.
  2. Sherlock M, O’Sullivan E, Agha A, Behan LA, Owens D, Finucane F, et al. Incidence and pathophysiology of severe hyponatremia in neurosurgical patients. Postgrad Med J. 2009; 85(1002): 171 – 5.
  3. Albanese A, Hindmarsh, Stanhope R. Management of hyponatremia in patients with acute cerebral insults. Arch Dis Child. 2001; 85(3): 246 – 251.
  4. Yee AH, Burns JD, Wijdicks EFM. Cerebral salt wasting: pathophysiology, diagnosis, and treatment. Neurosurg Clin N Am. 2010; 21(2): 339 – 52.
  5. Momi J, Tang CM, Abcar AC, Kujubu DA, Sim JJ. Hyponatremia – What is cerebral salt wasting?. Perm J. 2010; 14(2): 62 – 65.
  6. Einaudi S, Matarazzo P, Peretta P, Grossetti R, Giordano F, Altare F, et al. Hypothalamo-hypophysial dysfunction after traumatic brain injury in children and adolescents: A preliminary retrospective and prospective study. J Pediatr Endocrinol Metab. 2006; 19(5): 691 – 703.
  7. Steelman R, Corbitt B, Pate MFD. Early onset of cerebral salt wasting in a patient with head and facial injuries. J Oral Maxillofac Surg. 2006; 64(4): 746 – 7.
  8. Donati-Genet PC, Dubuis JM, Girardin E, Rimensberger PC. Acute symptomatic hyponatremia and cerebral salt wasting after head injury: An important clinical entity. J Pediatr Surg. 2001; 36(7): 1094 – 7.
  9. Navdeep SS, Rampal V, Dewan Y, Grewal SS. Factors predicting outcome in patients with severe head injury: Multivariate analysis. Indian J Neurotrauma. 2012; 9(1): 45 – 48.
  10. Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Stern RH. Hyponatremia treatment guidelines 2007: Expert panel recommendations. Am J Med. 2007; 120(11 Suppl 1): S1 – 21.
  11. Hannon MJ, Thompson CJ. The syndrome of inappropriate antidiuretic hormone: Prevalence, causes and consequences. Eur J Endocrinol. 2010; 162 Suppl 1: S5 – 12.
  12. Moro N, Katayama Y, Igarashi T, Mori T, Kawamata T, Kojima J. Hyponatremia in patients with traumatic brain injury: Incidence, mechanism, and response to sodium supplementation or retention therapy with hydrocortisone. Surg Neurol. 2007; 68(4): 387 – 93.
  13. Lohani S, Devkota UP. Hyponatremia in patients with traumatic brain injury: etiology, incidence, and severity correlation. World Neurosurg. 2011; 76(3-4): 355 – 60.
  14. Bangun EC, Prasetyo E, Oley MC. Correlation between the level of interleukin-6 serum and blood peripheral leukocyte in patients with severe traumatic brain injury. Bali Med J. 2019;8(3):S784-S787

How to Cite

Golden, N., Putra, J. A., Niryana, W., & Mardhika, P. E. (2020). The relationship between cerebral salt wasting syndrome and clinical outcome in severe and moderate traumatic brain injury patient at Sanglah Hospital, Bali, Indonesia. Bali Medical Journal, 9(2), 489–492. https://doi.org/10.15562/bmj.v9i2.1774

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