Abstract W P335: The Impact of Electrolyte Abnormalities in Primary Intracerebral Hemorrhage

Abstract

Background and Purpose: Electrolyte abnormalities are common in patients with hemorrhagic stroke. In subarachnoid hemorrhage for instance, hyponatremia is common and is independently associated with adverse outcomes. For patients with primary ICH, however, there is limited about electrolyte abnormalities. This study aims to examine the relationship between electrolyte abnormalities and outcomes in ICH patients. Methods: We retrospectively reviewed consecutive ICH patients in a single center stroke registry between 2008-2013. Patient demographics, clinical information including stroke severity (NIHSS) and ICH score, laboratory values and neuroimaging were collected. Admission electrolyte abnormalities for serum sodium, potassium and chloride were defined as any value outside the hospital’s reference range. Outcomes of interest included hematoma expansion, discharge mRS, length of stay (LOS) and poor discharge disposition (i.e., not to home or inpatient rehabilitation). Results: A total of 384 patients were included in this analysis. Serum sodium was abnormal in 47 patients (12.2%), potassium was abnormal in 46 patients (11.9%) and chloride was abnormal in 76 patients (19.8%). Hyponatremia was the most common sodium abnormality (46/47, 98%). Potassium and chloride abnormities were not associated with worse outcomes. Serum sodium abnormalities were associated with longer length of stay (11 vs 5 days, p=0.002), higher discharge mRS (5 vs 4, p=0.04) and poor disposition (60% vs 43%, p=0.03). There was no association with hematoma expansion. Although not significant for all hemorrhage severities, in patients with an ICH score ≤2, abnormal sodium was associated with a discharge mRS 4-6 (OR 2.49, 95% CI 1.16-5.39, p=0.02) and poor disposition (OR 2.55, 95% CI 1.29-5.02, p=0.01). Conclusions: Electrolyte abnormalities were not uncommon in our sample of ICH patients and hyponatremia was a frequent cause of abnormal serum sodium. Although potassium and chloride abnormalities were not associated with poor outcomes, serum sodium abnormalities were associated with worse functional outcomes, particularly in patients with milder hemorrhage severity. Further research is needed to determine if sodium correction can improve these outcomes.