Polyuria in relation to dysnatraemias in neurocritical care

Polyuria has the potential to cause severe water and sodium imbalance. We studied the epidemiology of polyuria in association with dysnatraemias and whether polyuria is an independent risk factor for higher mortality and poorer outcome in neurocritical care.

We performed an analysis of a 3-year prospective database containing 902 neurocritical care patients. Polyuria was defined as diuresis above 4000 ml/day, hyponatraemia as a serum sodium (SeNa) < 135 mmol/l and hypernatraemia as SeNa > 150 mmol/l.

We identified polyuria in 236 (26.2%) patients (639 days). Polyuric patients stayed in the neurointensive care unit (NICU) longer than those without polyuria (mean: 10.7 vs. 3.5 days, p < 0.001). These patients also had more frequent cerebral complications (p < 0.001) and a poorer outcome upon discharge from the NICU (p = 0.032). NICU mortality had borderline significance in relation to whether the patients were polyuric (p = 0.055). There were only 49 (20.8%) patients with dysnatraemia who were shown to have a significantly higher NICU mortality (p = 0.006). There were no differences in frequency between hyponatraemic and hypernatraemic polyuric patients (p = 0.127). Polyuric patients with hypernatraemia suffered poorer outcomes (p = 0.009) and higher NICU mortality (p < 0.001), but they had a lower Glasgow Coma Scale or GCS recorded at the onset of polyuria (p < 0.001). Cerebral salt wasting (CSW) was thought to be the cause of polyuria in 7 (3.0%) patients and central diabetes insipidus (CDI) in another 5 (2.1%) patients. Univariate models showed polyuria to be a risk factor for poor outcome (odds ratio [OR] = 1.39, p = 0.032) and had a borderline significance for mortality during their NICU stay (OR = 1.83, p = 0.055). These factors did not appear as significant following multivariate logistic regression analysis.

Polyuria often occurred in neurocritical care patients, but was not usually associated with sodium imbalance, CSW or CDI. We did not find that polyuria was a significant predictor of increased mortality or poorer outcome in NICU patients.