{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:01:53Z","timestamp":1789610513959,"version":"build-2803163510"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Hypernatremia is independently associated with increased mortality in critically ill patients. Few studies have evaluated the impact of hypernatremia on early mortality in patients with severe traumatic brain injury (TBI) treated in a neurocritical care unit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective review of patients with severe TBI (admission Glasgow Coma Scale score \u2264 8) treated in a single neurocritical care unit between 1986 and 2012 was performed. Patients with at least 3 serum sodium values were selected for the study. Patients with diabetes insipidus and those with hypernatremia on admission were excluded. The highest serum sodium level during the hospital stay was recorded, and hypernatremia was classified as none (\u2264 150 mEq\/L), mild (151\u2013155 mEq\/L), moderate (156\u2013160 mEq\/L), and severe (&gt; 160 mEq\/L). Multivariate Cox regression analysis was performed to determine independent predictors of early mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 588 patients with severe TBI were studied. The median number of serum sodium measurements for patients in this study was 17 (range 3\u2013190). No hypernatremia was seen in 371 patients (63.1%), mild hypernatremia in 77 patients (13.1%), moderate hypernatremia in 50 patients (8.5%), and severe hypernatremia in 90 patients (15.3%). Hypernatremia was detected within the 1st week of admission in 79.3% of patients (n = 172), with the majority of patients (46%) being diagnosed within 72 hours after admission. Acute kidney injury, defined as a rise in creatinine of \u2265 0.3 mg\/dl, was observed in 162 patients (27.6%) and was significantly associated with the degree of hypernatremia (p &lt; 0.001). At discharge, 148 patients (25.2%) had died. Hypernatremia was a significant independent predictor of mortality (hazard ratios for mild: 3.4, moderate: 4.4, and severe: 8.4; p &lt; 0.001). Survival analysis showed significantly lower survival rates for patients with greater degrees of hypernatremia (log-rank test, p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Hypernatremia after admission in patients with severe TBI was independently associated with greater risk of early mortality. In addition to severe hypernatremia, mild and moderate hypernatremia were significantly associated with increased early mortality in patients with severe TBI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2017.7.focus17418","type":"journal-article","created":{"date-parts":[[2017,11,1]],"date-time":"2017-11-01T03:37:00Z","timestamp":1509507420000},"page":"E2","source":"Crossref","is-referenced-by-count":70,"title":["Morbidity and mortality associated with hypernatremia in patients with severe traumatic brain injury"],"prefix":"10.3171","volume":"43","author":[{"given":"Aditya","family":"Vedantam","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia S.","family":"Robertson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankar P.","family":"Gopinath","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"N Engl J Med","first-page":"1493","article-title":"Hypernatremia","volume":"342","author":"Adrogu\u00e9 HJ","year":"2000","unstructured":"Adrogu\u00e9 HJ, Madias NE: Hypernatremia. N Engl J Med 342:1493\u20131499, 2000"},{"key":"b2","series-title":"J Crit Care","first-page":"163","article-title":"Hypernatremia in the neurologic intensive care unit: how high is too high?","volume":"21","author":"Aiyagari V","year":"2006","unstructured":"Aiyagari V, Deibert E, Diringer MN: Hypernatremia in the neurologic intensive care unit: how high is too high? J Crit Care 21:163\u2013172, 2006"},{"key":"b3","series-title":"J Physiol","first-page":"243","article-title":"Effects of hypernatraemia in the central nervous system and its therapy in rats and rabbits","volume":"492","author":"Ayus JC","year":"1996","unstructured":"Ayus JC, Armstrong DL, Arieff AI: Effects of hypernatraemia in the central nervous system and its therapy in rats and rabbits. J Physiol 492:243\u2013255, 1996"},{"key":"b4","series-title":"Clin Neurol Neurosurg","first-page":"164","article-title":"The relation of early hypernatremia with clinical outcome in patients suffering from aneurysmal subarachnoid hemorrhage","volume":"123","author":"Beseoglu K","year":"2014","unstructured":"Beseoglu K, Etminan N, Steiger HJ, H\u00e4nggi D: The relation of early hypernatremia with clinical outcome in patients suffering from aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg 123:164\u2013168, 2014"},{"key":"b5","series-title":"Nephrol Dial Transplant","first-page":"2510","article-title":"Association between hypernatraemia acquired in the ICU and mortality: a cohort study","volume":"25","author":"Darmon M","year":"2010","unstructured":"Darmon M, Timsit JF, Francais A, Nguile-Makao M, Adrie C, Cohen Y, : Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transplant 25:2510\u20132515, 2010"},{"key":"b6","series-title":"Crit Care Med","first-page":"1433","article-title":"Continuous hypertonic saline therapy and the occurrence of complications in neurocritically ill patients","volume":"37","author":"Froelich M","year":"2009","unstructured":"Froelich M, Ni Q, Wess C, Ougorets I, H\u00e4rtl R: Continuous hypertonic saline therapy and the occurrence of complications in neurocritically ill patients. Crit Care Med 37:1433\u20131441, 2009"},{"key":"b7","series-title":"Am J Physiol","first-page":"F441","article-title":"Influence of hypertonic saline on canine renal blood flow and renin release","volume":"237","author":"Gerber JG","year":"1979","unstructured":"Gerber JG, Branch RA, Nies AS, Hollifield JW, Gerkens JF: Influence of hypertonic saline on canine renal blood flow and renin release. Am J Physiol 237:F441\u2013F446, 1979"},{"key":"b8","series-title":"J Am Coll Surg","first-page":"477","article-title":"Acute diabetes insipidus in severe head injury: a prospective study","volume":"207","author":"Hadjizacharia P","year":"2008","unstructured":"Hadjizacharia P, Beale EO, Inaba K, Chan LS, Demetriades D: Acute diabetes insipidus in severe head injury: a prospective study. J Am Coll Surg 207:477\u2013484, 2008"},{"key":"b9","series-title":"Intensive Care Med","first-page":"27","article-title":"Controlled fall in natremia and risk of seizures in hypertonic dehydration","volume":"5","author":"Kahn A","year":"1979","unstructured":"Kahn A, Brachet E, Blum D: Controlled fall in natremia and risk of seizures in hypertonic dehydration. Intensive Care Med 5:27\u201331, 1979"},{"key":"b10","series-title":"Ann Intensive Care","first-page":"35","article-title":"Hypernatremia in patients with severe traumatic brain injury: a systematic review","volume":"3","author":"Kolmodin L","year":"2013","unstructured":"Kolmodin L, Sekhon MS, Henderson WR, Turgeon AF, Griesdale DE: Hypernatremia in patients with severe traumatic brain injury: a systematic review. Ann Intensive Care 3:35, 2013"},{"key":"b11","series-title":"Injury","first-page":"1213","article-title":"Hypernatremia severity and the risk of death after traumatic brain injury","volume":"44","author":"Li M","year":"2013","unstructured":"Li M, Hu YH, Chen G: Hypernatremia severity and the risk of death after traumatic brain injury. Injury 44:1213\u20131218, 2013"},{"key":"b12","series-title":"J Crit Care","first-page":"216","article-title":"Hypernatremia in critically ill patients","volume":"28","author":"Lindner G","unstructured":"Lindner G, Funk GC: Hypernatremia in critically ill patients. J Crit Care 28:216.e11\u2013216.e20, 2013"},{"key":"b13","series-title":"Intensive Care Med","first-page":"1718","article-title":"Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality","volume":"36","author":"Lindner G","year":"2010","unstructured":"Lindner G, Funk GC, Lassnigg A, Mouhieddine M, Ahmad SA, Schwarz C, : Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality. Intensive Care Med 36:1718\u20131723, 2010"},{"key":"b14","series-title":"Am J Kidney Dis","first-page":"952","article-title":"Hypernatremia in the critically ill is an independent risk factor for mortality","volume":"50","author":"Lindner G","year":"2007","unstructured":"Lindner G, Funk GC, Schwarz C, Kneidinger N, Kaider A, Schneeweiss B, : Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis 50:952\u2013957, 2007"},{"key":"b15","series-title":"Crit Care","first-page":"R110","article-title":"The relation between the incidence of hypernatremia and mortality in patients with severe traumatic brain injury","volume":"13","author":"Maggiore U","year":"2009","unstructured":"Maggiore U, Picetti E, Antonucci E, Parenti E, Regolisti G, Mergoni M, : The relation between the incidence of hypernatremia and mortality in patients with severe traumatic brain injury. Crit Care 13:R110, 2009"},{"key":"b16","series-title":"Nat Clin Pract Nephrol","first-page":"439","article-title":"Improving outcomes of acute kidney injury: report of an initiative","volume":"3","author":"Molitoris BA","year":"2007","unstructured":"Molitoris BA, Levin A, Warnock DG, Joannidis M, Mehta RL, Kellum JA, : Improving outcomes of acute kidney injury: report of an initiative. Nat Clin Pract Nephrol 3:439\u2013442, 2007"},{"key":"b17","series-title":"Anaesthesia","first-page":"514","article-title":"Acquired hypernatraemia is an independent predictor of mortality in critically ill patients","volume":"64","author":"O\u2019Donoghue SD","year":"2009","unstructured":"O\u2019Donoghue SD, Dulhunty JM, Bandeshe HK, Senthuran S, Gowardman JR: Acquired hypernatraemia is an independent predictor of mortality in critically ill patients. Anaesthesia 64:514\u2013520, 2009"},{"key":"b18","series-title":"Neurosurgery","first-page":"749","article-title":"Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage","volume":"50","author":"Qureshi AI","year":"2002","unstructured":"Qureshi AI, Suri MF, Sung GY, Straw RN, Yahia AM, Saad M, : Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 50:749\u2013756, 2002"},{"issue":"(Suppl 1","key":"b19","series-title":"Crit Care","first-page":"P355","article-title":"Impact of hypernatremia on patients with severe traumatic brain injury","volume":"14","author":"Shehata M","year":"2010","unstructured":"Shehata M, Ragab D, Khaled M, Hegazy M, Hussein A, Khaled H: Impact of hypernatremia on patients with severe traumatic brain injury. Crit Care 14(Suppl 1):P355, 2010"},{"key":"b20","series-title":"J Neurosurg Anesthesiol","first-page":"57","article-title":"Disturbances of sodium in critically ill adult neurologic patients: a clinical review","volume":"18","author":"Tisdall M","year":"2006","unstructured":"Tisdall M, Crocker M, Watkiss J, Smith M: Disturbances of sodium in critically ill adult neurologic patients: a clinical review. J Neurosurg Anesthesiol 18:57\u201363, 2006"},{"key":"b21","series-title":"J Clin Invest","first-page":"726","article-title":"Regulation of renal blood flow by plasma chloride","volume":"71","author":"Wilcox CS","year":"1983","unstructured":"Wilcox CS: Regulation of renal blood flow by plasma chloride. J Clin Invest 71:726\u2013735, 1983"},{"key":"b1","series-title":"N Engl J Med","first-page":"1493","article-title":"Hypernatremia","volume":"342","author":"Adrogu\u00e9 HJ","year":"2000","unstructured":"Adrogu\u00e9 HJ, Madias NE: Hypernatremia. N Engl J Med 342:1493\u20131499, 2000"},{"key":"b2","series-title":"J Crit Care","first-page":"163","article-title":"Hypernatremia in the neurologic intensive care unit: how high is too high?","volume":"21","author":"Aiyagari V","year":"2006","unstructured":"Aiyagari V, Deibert E, Diringer MN: Hypernatremia in the neurologic intensive care unit: how high is too high? J Crit Care 21:163\u2013172, 2006"},{"key":"b3","series-title":"J Physiol","first-page":"243","article-title":"Effects of hypernatraemia in the central nervous system and its therapy in rats and rabbits","volume":"492","author":"Ayus JC","year":"1996","unstructured":"Ayus JC, Armstrong DL, Arieff AI: Effects of hypernatraemia in the central nervous system and its therapy in rats and rabbits. J Physiol 492:243\u2013255, 1996"},{"key":"b4","series-title":"Clin Neurol Neurosurg","first-page":"164","article-title":"The relation of early hypernatremia with clinical outcome in patients suffering from aneurysmal subarachnoid hemorrhage","volume":"123","author":"Beseoglu K","year":"2014","unstructured":"Beseoglu K, Etminan N, Steiger HJ, H\u00e4nggi D: The relation of early hypernatremia with clinical outcome in patients suffering from aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg 123:164\u2013168, 2014"},{"key":"b5","series-title":"Nephrol Dial Transplant","first-page":"2510","article-title":"Association between hypernatraemia acquired in the ICU and mortality: a cohort study","volume":"25","author":"Darmon M","year":"2010","unstructured":"Darmon M, Timsit JF, Francais A, Nguile-Makao M, Adrie C, Cohen Y, : Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transplant 25:2510\u20132515, 2010"},{"key":"b6","series-title":"Crit Care Med","first-page":"1433","article-title":"Continuous hypertonic saline therapy and the occurrence of complications in neurocritically ill patients","volume":"37","author":"Froelich M","year":"2009","unstructured":"Froelich M, Ni Q, Wess C, Ougorets I, H\u00e4rtl R: Continuous hypertonic saline therapy and the occurrence of complications in neurocritically ill patients. Crit Care Med 37:1433\u20131441, 2009"},{"key":"b7","series-title":"Am J Physiol","first-page":"F441","article-title":"Influence of hypertonic saline on canine renal blood flow and renin release","volume":"237","author":"Gerber JG","year":"1979","unstructured":"Gerber JG, Branch RA, Nies AS, Hollifield JW, Gerkens JF: Influence of hypertonic saline on canine renal blood flow and renin release. Am J Physiol 237:F441\u2013F446, 1979"},{"key":"b8","series-title":"J Am Coll Surg","first-page":"477","article-title":"Acute diabetes insipidus in severe head injury: a prospective study","volume":"207","author":"Hadjizacharia P","year":"2008","unstructured":"Hadjizacharia P, Beale EO, Inaba K, Chan LS, Demetriades D: Acute diabetes insipidus in severe head injury: a prospective study. J Am Coll Surg 207:477\u2013484, 2008"},{"key":"b9","series-title":"Intensive Care Med","first-page":"27","article-title":"Controlled fall in natremia and risk of seizures in hypertonic dehydration","volume":"5","author":"Kahn A","year":"1979","unstructured":"Kahn A, Brachet E, Blum D: Controlled fall in natremia and risk of seizures in hypertonic dehydration. Intensive Care Med 5:27\u201331, 1979"},{"key":"b10","series-title":"Ann Intensive Care","first-page":"35","article-title":"Hypernatremia in patients with severe traumatic brain injury: a systematic review","volume":"3","author":"Kolmodin L","year":"2013","unstructured":"Kolmodin L, Sekhon MS, Henderson WR, Turgeon AF, Griesdale DE: Hypernatremia in patients with severe traumatic brain injury: a systematic review. Ann Intensive Care 3:35, 2013"},{"key":"b11","series-title":"Injury","first-page":"1213","article-title":"Hypernatremia severity and the risk of death after traumatic brain injury","volume":"44","author":"Li M","year":"2013","unstructured":"Li M, Hu YH, Chen G: Hypernatremia severity and the risk of death after traumatic brain injury. Injury 44:1213\u20131218, 2013"},{"key":"b12","series-title":"J Crit Care","first-page":"216","article-title":"Hypernatremia in critically ill patients","volume":"28","author":"Lindner G","unstructured":"Lindner G, Funk GC: Hypernatremia in critically ill patients. J Crit Care 28:216.e11\u2013216.e20, 2013"},{"key":"b13","series-title":"Intensive Care Med","first-page":"1718","article-title":"Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality","volume":"36","author":"Lindner G","year":"2010","unstructured":"Lindner G, Funk GC, Lassnigg A, Mouhieddine M, Ahmad SA, Schwarz C, : Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality. Intensive Care Med 36:1718\u20131723, 2010"},{"key":"b14","series-title":"Am J Kidney Dis","first-page":"952","article-title":"Hypernatremia in the critically ill is an independent risk factor for mortality","volume":"50","author":"Lindner G","year":"2007","unstructured":"Lindner G, Funk GC, Schwarz C, Kneidinger N, Kaider A, Schneeweiss B, : Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis 50:952\u2013957, 2007"},{"key":"b15","series-title":"Crit Care","first-page":"R110","article-title":"The relation between the incidence of hypernatremia and mortality in patients with severe traumatic brain injury","volume":"13","author":"Maggiore U","year":"2009","unstructured":"Maggiore U, Picetti E, Antonucci E, Parenti E, Regolisti G, Mergoni M, : The relation between the incidence of hypernatremia and mortality in patients with severe traumatic brain injury. Crit Care 13:R110, 2009"},{"key":"b16","series-title":"Nat Clin Pract Nephrol","first-page":"439","article-title":"Improving outcomes of acute kidney injury: report of an initiative","volume":"3","author":"Molitoris BA","year":"2007","unstructured":"Molitoris BA, Levin A, Warnock DG, Joannidis M, Mehta RL, Kellum JA, : Improving outcomes of acute kidney injury: report of an initiative. Nat Clin Pract Nephrol 3:439\u2013442, 2007"},{"key":"b17","series-title":"Anaesthesia","first-page":"514","article-title":"Acquired hypernatraemia is an independent predictor of mortality in critically ill patients","volume":"64","author":"O\u2019Donoghue SD","year":"2009","unstructured":"O\u2019Donoghue SD, Dulhunty JM, Bandeshe HK, Senthuran S, Gowardman JR: Acquired hypernatraemia is an independent predictor of mortality in critically ill patients. Anaesthesia 64:514\u2013520, 2009"},{"key":"b18","series-title":"Neurosurgery","first-page":"749","article-title":"Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage","volume":"50","author":"Qureshi AI","year":"2002","unstructured":"Qureshi AI, Suri MF, Sung GY, Straw RN, Yahia AM, Saad M, : Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 50:749\u2013756, 2002"},{"issue":"(Suppl 1","key":"b19","series-title":"Crit Care","first-page":"P355","article-title":"Impact of hypernatremia on patients with severe traumatic brain injury","volume":"14","author":"Shehata M","year":"2010","unstructured":"Shehata M, Ragab D, Khaled M, Hegazy M, Hussein A, Khaled H: Impact of hypernatremia on patients with severe traumatic brain injury. Crit Care 14(Suppl 1):P355, 2010"},{"key":"b20","series-title":"J Neurosurg Anesthesiol","first-page":"57","article-title":"Disturbances of sodium in critically ill adult neurologic patients: a clinical review","volume":"18","author":"Tisdall M","year":"2006","unstructured":"Tisdall M, Crocker M, Watkiss J, Smith M: Disturbances of sodium in critically ill adult neurologic patients: a clinical review. J Neurosurg Anesthesiol 18:57\u201363, 2006"},{"key":"b21","series-title":"J Clin Invest","first-page":"726","article-title":"Regulation of renal blood flow by plasma chloride","volume":"71","author":"Wilcox CS","year":"1983","unstructured":"Wilcox CS: Regulation of renal blood flow by plasma chloride. J Clin Invest 71:726\u2013735, 1983"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/43\/5\/article-pE2.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/43\/5\/article-pE2.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/43\/5\/article-pE2.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:06:11Z","timestamp":1779527171000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/43\/5\/article-pE2.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":42,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2017.7.focus17418","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11]]}}}