Association between serum osmolality and risk of in-hospital mortality in patients with intracerebral hemorrhage

 You described a problem. WHAT IS THE PREVENTION? With no solution every business manager in the world would have you fired!

Association between serum osmolality and risk of in-hospital mortality in patients with intracerebral hemorrhage

Zhaosuo Hu^1,2Quan Sha^1*

• ¹School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China
• ²Department of Clinical Laboratory, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China

Aim: This study aimed to analyze the association between serum osmolality and the risk of in-hospital mortality in intracerebral hemorrhage (ICH) patients.

Methods: In this retrospective cohort study, data of a total of 1,837 ICH patients aged ≥18 years were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV). Serum osmolality and blood urea nitrogen (BUN)-to-creatinine (Cr) ratio (BCR) were used as the main variables to assess their association with the risk of in-hospital mortality in ICH patients after first intensive care unit (ICU) admission using a univariable Cox model. Univariable and multivariable Cox regression analyses were applied to explore the associations between serum osmolality, BCR, and in-hospital mortality of ICH patients. Hazard ratio (HR) and 95% confidence intervals (CIs) were calculated.

Results: The median survival duration of all participants was 8.29 (4.61–15.24) days. Serum osmolality of ≥295 mmol/L was correlated with an increased risk of in-hospital mortality in patients with ICH (HR = 1.43, 95%CI: 1.14–1.78). BCR of >20 was not significantly associated with the risk of in-hospital mortality in ICH patients. A subgroup analysis indicated an increased risk of in-hospital mortality among ICH patients who were women, belonged to white or Black race, or had complications with acute kidney injury (AKI).

Conclusion: High serum osmolality was associated with an increased risk of in-hospital mortality among ICH patients.

Introduction

Intracerebral hemorrhage (ICH) is a common neurological complication, accounting for approximately 10–20% of all stroke types (1–3). ICH manifests as a rapidly expanding hematoma within the brain tissue, with the potential to extend into the ventricular system and subarachnoid or dural spaces (4). Acute ICH is a medical complication with high mortality, morbidity, and disability rates (5). Evidence from previous studies has revealed that an estimated 10–30 patients per 100,000 persons are affected annually, with 1-year mortality rates as high as 50% in the first 30 days (6). Therefore, accurate prognostic assessment is essential in the clinical management of ICH patients.

Serum osmolality is the serum concentration of ions and particles dissolved in body fluids, reflecting fluid balance and renal function, and is strongly influenced by sodium, potassium, glucose, and urea nitrogen concentrations (7). Dehydration, reflected by high osmolality, is an important risk factor affecting the prognosis of ICU patients (8, 9). The blood urea nitrogen (BUN)-to-creatinine (Cr) ratio (BCR) is clinically considered a simple marker reflecting hydration status (10). However, the BCR is not a specific marker indicating dehydration and may be affected by catabolic status (such as surgery and sepsis) and drug use (11, 12). Direct measurement of plasma osmolality is considered the gold standard to reflect hydration status (13). However, plasma osmolality measurement is not routinely performed, owing to its complexity and high cost. Considering this limitation, serum osmolality calculated by indicators such as sodium, potassium, glucose, and BUN was proposed to replace direct measurement techniques (14). The European Society for Clinical Nutrition and Metabolism (ESPEN) equation has been proven to be highly accurate and has been recommended as a marker for the clinical assessment of dehydration (7, 12). Recent studies have found that serum osmolality calculated by using the ESPEN equation is significantly related to the short-term mortality risk of acute ischemic stroke (15). Moreover, the calculated serum osmolality has a better predictive value for neurological deterioration than BCR for patients hospitalized due to acute ischemic stroke (16). However, BCR also demonstrates outstanding performance in predicting the risk of death in ICH patients (17, 18). Thus, the prognostic value of serum osmolality for ICH still remains unclear.

This study aimed to analyze the association between serum osmolality and the risk of in-hospital mortality in ICH patients based on the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The results were compared with those obtained by the BCR. A subgroup analysis was performed in terms of age, gender, and Glasgow Coma Scale (GCS) score.

More at link.