Admission hyponatremia may independently predict unfavorable postreperfusion outcomes

A recent study found the impact of hyponatremia (plasma sodium <136 mmol/L) on patients undergoing intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT) for acute ischemic stroke. The study revealed that Hyponatremia is associated with unfavorable outcomes after reperfusion treatment in acute ischemic stroke. 

The findings were published in the European Journal of Neurology.

This comprehensive analysis encompassed data from Isala Hospital in the Netherlands of 680 patients treated in 2019 and 2020, revealed that hyponatremia was a common occurrence, with 14% of patients presenting with low sodium levels on admission. The study explored the association between hyponatremia and postreperfusion outcomes, focusing on factors such as modified Rankin Scale (mRS) scores at 3 months, in-hospital mortality, symptomatic intracranial hemorrhage, infarct core, and penumbra volumes.

The findings unveiled a significant link between hyponatremia and adverse outcomes. Patients with low sodium levels experienced a 76% increased odds of having a worse mRS score at the 3-month follow-up, and a notable 139% increased odds of in-hospital mortality. While hyponatremia did not show a direct correlation with symptomatic intracranial hemorrhage, it was associated with a larger infarct core and a higher core-to-penumbra ratio.

The study highlighted the importance of these findings that indicate that admission hyponatremia is an independent factor predicting unfavorable postreperfusion outcomes. This raises crucial questions about the potential impact of correcting hyponatremia on the prognosis of stroke patients.

Future research is required to delve deeper into the options of correcting hyponatremia and how it could be a viable intervention to improve outcomes for stroke patients treated with IVT and/or EVT. As stroke management evolves, this investigation adds a critical input to optimize the care strategies for acute ischemic stroke and also emphasize the significance of addressing even seemingly unrelated factors for better patient outcomes.

Reference:

Pelouto, A., Reimer, J., Hoorn, E. J., Zandbergen, A. A. M., & den Hertog, H. M. (2023). Hyponatremia is associated with unfavorable outcomes after reperfusion treatment in acute ischemic stroke. In European Journal of Neurology. Wiley. https://doi.org/10.1111/ene.16156