{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T20:35:28Z","timestamp":1789850128652,"version":"4.0.1"},"reference-count":26,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,6,21]]},"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Hypernatraemia is one of the major electrolyte disorders associated with mortality among critically ill patients in intensive care units (ICUs). It is unclear whether this applies to patients with cerebrovascular diseases in whom high sodium concentrations may be allowed in order to prevent cerebral oedema. This study aimed to examine the association between ICU-acquired hypernatraemia and the prognosis of patients with cerebrovascular diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The incidence of ICU-acquired hypernatraemia was assessed retrospectively in a single tertiary care facility in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adult patients (\u226518 years old) whose length of stay in ICU was &gt;2 days and those whose serum sodium concentrations were 130\u2013149 mEq\/L on admission to ICU were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>28-day in-hospital mortality risk was assessed by Cox regression analysis. Hypernatraemia was defined as serum sodium concentration \u2265150\u2009mEq\/L. Using multivariate analysis, we examined whether ICU-acquired hypernatraemia and the main symptom present at ICU admission were associated with time to death among ICU patients. We also evaluated how the maximum and minimum sodium concentrations during ICU stay were associated with mortality, using restricted cubic splines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1756 patients, 121 developed ICU-acquired hypernatraemia. Multivariate Cox proportional hazard analysis revealed an association between ICU-acquired hypernatraemia and 28-day mortality (adjusted HR, 3.07 (95% CI 2.12 to 4.44)). The interaction between ICU-acquired hypernatraemia and cerebrovascular disease was significantly associated with 28-day mortality (HR, 3.03 (95% CI 1.29 to 7.15)). The restricted cubic splines analysis of maximum serum sodium concentration in ICU patients determined a threshold maximum of 147 mEq\/L. There was no significant association between minimum sodium concentration and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ICU-acquired hypernatraemia was associated with an increased mortality rate among critically ill patients with cerebrovascular diseases; the threshold maximum serum sodium concentration associated with mortality was 147 mEq\/L.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-016248","type":"journal-article","created":{"date-parts":[[2017,8,18]],"date-time":"2017-08-18T20:10:20Z","timestamp":1503087020000},"page":"e016248","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["The association between intensive care unit-acquired hypernatraemia and mortality in critically ill patients with cerebrovascular diseases: a single-centre cohort study in Japan"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3831-7241","authenticated-orcid":false,"given":"Takahiro","family":"Imaizumi","sequence":"first","affiliation":[{"name":"Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Nakatochi","sequence":"additional","affiliation":[{"name":"Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiro","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Rheumatology, Chubu Rosai Hospital, Nagoya, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rie","family":"Nomura","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenshi","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michitaka","family":"Maekawa","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taishi","family":"Yamakawa","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Katsuno","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoichi","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,8,18]]},"reference":[{"key":"2025120519303749000_7.8.e016248.1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2007.08.016"},{"key":"2025120519303749000_7.8.e016248.2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfm831"},{"key":"2025120519303749000_7.8.e016248.3","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1111\/j.1365-2044.2008.05857.x","article-title":"Acquired hypernatraemia is an independent predictor of mortality in critically ill patients","volume":"64","author":"O'Donoghue","year":"2009","journal-title":"Anaesthesia"},{"key":"2025120519303749000_7.8.e016248.4","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq067"},{"key":"2025120519303749000_7.8.e016248.5","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.jcrc.2012.11.013","article-title":"Intensive care unit-acquired hypernatremia is an independent predictor of increased mortality and length of stay","volume":"28","author":"Waite","year":"2013","journal-title":"J Crit Care"},{"key":"2025120519303749000_7.8.e016248.6","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.amjms.2016.01.027","article-title":"Risk factors and outcomes in patients with hypernatremia and sepsis","volume":"351","author":"Ni","year":"2016","journal-title":"Am J Med Sci"},{"key":"2025120519303749000_7.8.e016248.7","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.clineuro.2014.05.022","article-title":"The relation of early hypernatremia with clinical outcome in patients suffering from aneurysmal subarachnoid hemorrhage","volume":"123","author":"Beseoglu","year":"2014","journal-title":"Clin Neurol Neurosurg"},{"key":"2025120519303749000_7.8.e016248.8","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000003840","article-title":"Prognostic value of ICU-acquired hypernatremia in patients with neurological dysfunction","volume":"95","author":"Hu","year":"2016","journal-title":"Medicine"},{"key":"2025120519303749000_7.8.e016248.9","doi-asserted-by":"publisher","DOI":"10.1159\/000368353"},{"key":"2025120519303749000_7.8.e016248.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2005.10.002"},{"key":"2025120519303749000_7.8.e016248.11","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.jcrc.2014.06.008","article-title":"Admission high serum sodium is not associated with increased intensive care unit mortality risk in respiratory patients","volume":"29","author":"Bihari","year":"2014","journal-title":"J Crit Care"},{"key":"2025120519303749000_7.8.e016248.12","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2014.16.3.146"},{"key":"2025120519303749000_7.8.e016248.13","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199803000-00011"},{"key":"2025120519303749000_7.8.e016248.14","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-198608000-00028"},{"key":"2025120519303749000_7.8.e016248.15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"2025120519303749000_7.8.e016248.16","doi-asserted-by":"publisher","DOI":"10.1038\/kisup.2012.1"},{"key":"2025120519303749000_7.8.e016248.17","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.19.5.604"},{"key":"2025120519303749000_7.8.e016248.18","doi-asserted-by":"publisher","DOI":"10.1159\/000091226"},{"key":"2025120519303749000_7.8.e016248.19","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1056\/NEJMoa1509139","article-title":"Trial of continuous or interrupted chest compressions during CPR","volume":"373","author":"Nichol","year":"2015","journal-title":"N Engl J Med"},{"key":"2025120519303749000_7.8.e016248.20","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.jclinepi.2014.11.022","article-title":"Nonlinear modeling was applied thoughtfully for risk prediction: the\u00a0Prostate Biopsy Collaborative Group","volume":"68","author":"Nieboer","year":"2015","journal-title":"J Clin Epidemiol"},{"key":"2025120519303749000_7.8.e016248.21","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199906000-00029"},{"key":"2025120519303749000_7.8.e016248.22","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfr428"},{"key":"2025120519303749000_7.8.e016248.23","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s12028-013-9824-3","article-title":"Induced and sustained hypernatremia for the prevention and treatment of cerebral edema following brain injury","volume":"19","author":"Ryu","year":"2013","journal-title":"Neurocrit Care"},{"key":"2025120519303749000_7.8.e016248.24","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000069"},{"key":"2025120519303749000_7.8.e016248.25","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1159\/000351754","article-title":"Comparison of the European and Japanese guidelines for the acute management of intracerebral hemorrhage","volume":"35","author":"Toyoda","year":"2013","journal-title":"Cerebrovasc Dis"},{"key":"2025120519303749000_7.8.e016248.26","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(82)90522-8"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-016248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T03:30:43Z","timestamp":1764991843000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-016248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2017,8,18]]},"published-print":{"date-parts":[[2017,8]]}},"alternative-id":["10.1136\/bmjopen-2017-016248"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-016248","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8]]}}}