Association between radiological findings and clinical outcome in secondary dysnatremia to acute traumatic brain injury

Abstract

Background/objective

Traumatic brain injury (TBI) is a major cause of morbidity and mortality, with symptoms ranging from seizures to speech disorders. TBI often requires stabilization, neuroimaging, and correction of metabolic imbalances like dysnatremia, which can worsen outcomes. This study evaluates the relationship between dysnatremia, clinical parameters, and neuroimaging findings in acute TBI patients.

Methods

A multicenter retrospective cohort study was conducted in three hospitals in Guayaquil, Ecuador, including 200 ICU patients with acute TBI from 2018 to 2023. Data were collected from clinical histories, neuroimaging, and biochemical analyses, with serum sodium levels measured at admission, 24, and 48 h post-admission. Statistical analyses included Chi-square tests, Kruskal-Wallis tests, Pearson correlation, and logistic regression to assess associations.

Results

Of the 200 patients, 85.5% were male. Alcohol consumption was higher in patients with dysnatremia (p = 0.010). Glasgow Coma Scale (GCS) and FOUR Scale scores were lower in hypernatremic patients at both admission and 48 h (p < 0.001). Hypernatremia was linked to increased ventilatory support (94.5%) and higher mortality (41.8%) (p = 0.017). Neuroimaging showed associations between hypernatremia and subarachnoid hemorrhage, cerebral edema, and contusions (p < 0.05). Logistic regression revealed that higher GCS scores were linked to reduced mortality (OR = 0.717, p < 0.001).

Conclusions

Hypernatremia correlates with lower neurological scores, abnormal neuroimaging findings, increased ventilatory support, and higher mortality in patients with acute TBI. Serum sodium monitoring may aid early risk stratification and guide critical care interventions. Prospective studies are warranted to standardize protocols and optimize dysnatremia management in TBI.