title: Moderate-to-large increases in perioperative serum sodium concentration associated with adverse neurologic events after continuous flow left ventricular assist device implantation.
abstract: OBJECTIVE
  It was hypothesized that preoperative hyponatremia is associated with increased 30-day mortality after left ventricular assist device placement, and that large increases in sodium concentration are associated with adverse neurologic events and 30-day mortality.
  
  
  METHODS
  Data were collected retrospectively on all patients having continuous flow left ventricular assist device implantation between January 1, 2009 and March 31, 2013. Preoperative variables, operative variables, and perioperative sodium concentrations were recorded. Both 30-day mortality and 72-hour adverse neurologic events (stroke or seizure) were recorded as primary outcome variables. Preoperative sodium and Δ sodium (postoperative sodium-preoperative sodium) were analyzed as tests for 30-day mortality and adverse neurologic events using receiver operating characteristic curves. Both crude and adjusted logistic regression analyses were used to estimate odds ratios for the outcome variables.
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  Patients having durable continuous flow left ventricular assist device placement.
  
  
  METHODS
  None.
  
  
  RESULTS
  Among 88 patients, 30-day mortality was 14% (12 of 88) and the rate of perioperative stroke or seizure was 9% (8 of 88). There were 3 strokes and 5 tonic-clonic seizures. Preoperative sodium was a poor discriminative test for 30-day mortality and stroke or seizure (AUC=0.47 and 0.57, respectively). Δ sodium was a poor discriminative test for 30-day mortality, but a fair discriminative test for stroke or seizure (AUC=0.55 and 0.78, respectively). Δ sodium was a good discriminative test for seizure alone (AUC=0.82) and a fair discriminative test for stroke alone (AUC=0.70). It also increased the odds of stroke or seizure significantly, even when adjusting for possible confounders.
  
  
  CONCLUSIONS
  Moderate-to-large increases in sodium concentration during left ventricular assist device placement appear to be associated with adverse postoperative neurologic events. Preoperative hyponatremia has no relationship with 30-day mortality or adverse perioperative neurologic events.
authors.affiliation: Department of Anesthesiology, University of Maryland, Baltimore, MD.
authors.forename: Michael
authors.initials: M
authors.lastname: Mazzeffi
authors.affiliation: Department of Pharmacy, Emory University, Atlanta, GA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Paciullo
authors.affiliation: Department of Surgery-Division of Cardiothoracic Surgery, Emory University, Atlanta, GA.
authors.forename: J David
authors.initials: JD
authors.lastname: Vega
authors.affiliation: Department of Surgery-Division of Cardiothoracic Surgery, Emory University, Atlanta, GA.
authors.forename: Duc
authors.initials: D
authors.lastname: Nguyen
authors.affiliation: Emory Center for Critical Care & Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, GA. Electronic address: mmazzeff@hotmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Connor
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D012964:Sodium
keywords: hyponatremia; mortality; seizure; stroke; ventricular assist device