Aneurysmal subarachnoid hemorrhage in elderly patients: fluctuations in serum sodium levels were associated with poor neurological outcomes

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-06-09 DOI:10.1016/j.jocn.2025.111370

Wataru Uchida, Tomoya Kamide, Kouichi Misaki, Daisuke Wajima Sho Takata, Mitsutoshi Nakada

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引用次数: 0

Abstract

Objective

To investigate the clinical characteristics and treatment outcomes of aneurysmal subarachnoid hemorrhage (aSAH) in elderly (aged ≥75 years) and nonelderly patients (<75 years).

Methods

This single-center retrospective study enrolled 59 patients with aSAH between November 2019 and November 2023. Patients were categorized into elderly and nonelderly groups based on a cutoff of 75 years, with further subdivisions of the elderly group based on the modified Rankin Scale (mRS) score at discharge into favorable (mRS score 0–3) and poor (mRS score 4–6) outcomes. Clinical data, including the World Federation of Neurosurgical Societies (WFNS) grade, aneurysm size, and various clinical and laboratory parameters, were analyzed.

Results

The elderly group exhibited higher mRS scores 4–6 and larger aneurysms. Univariate and multivariate analyses identified fluctuating serum sodium levels as a significant predictor of poor neurological outcomes (P = 0.048) in elderly patients. The receiver operating characteristic curve of serum sodium variability showed a cutoff value of 10 mEq/L for good neurological outcomes (sensitivity, 84.6 %; specificity, 66.7 %; area under the curve, 0.87).

Conclusions

Elderly patients with aSAH typically present with more severe symptoms, which contribute to poorer outcomes, and larger aneurysms. However, stabilizing serum sodium fluctuations during treatment could improve the prognosis, emphasizing the need for careful perioperative management.

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老年患者动脉瘤性蛛网膜下腔出血：血清钠水平波动与神经预后不良相关

目的探讨高龄（≥75岁）和非高龄（≥75岁）患者动脉瘤性蛛网膜下腔出血（aSAH）的临床特点及治疗效果。方法该单中心回顾性研究纳入了2019年11月至2023年11月期间59例aSAH患者。患者以75岁为截止年龄分为老年组和非老年组，老年组在出院时根据改进的兰金量表（mRS）评分进一步细分为良好（mRS评分0-3）和差（mRS评分4-6）。临床资料，包括世界神经外科学会联合会（WFNS）分级、动脉瘤大小以及各种临床和实验室参数进行分析。结果老年组mRS评分4-6分较高，动脉瘤较大。单因素和多因素分析表明，波动的血清钠水平是老年患者神经预后不良的重要预测因子（P = 0.048）。血清钠变异性受试者工作特征曲线显示，10 mEq/L为良好神经预后的临界值(敏感性为84.6%；特异性为66.7%；曲线下面积，0.87)。结论老年aSAH患者通常表现出更严重的症状，导致预后更差，动脉瘤更大。然而，在治疗期间稳定血清钠波动可以改善预后，强调需要仔细的围手术期管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.