title: Prevalence and risk factors for central diabetes insipidus in cardiac arrest survivor treated with targeted temperature management.
abstract: OBJECTIVE
  Central diabetes insipidus (CDI) is a marker of severe brain injury. Here we aimed to investigate the prevalence and risk factors of CDI in cardiac arrest survivors treated with targeted temperature management (TTM).
  
  
  METHODS
  This retrospective observational study included consecutive adult cardiac arrest survivors treated with TTM between 2008 and 2014. Central diabetes insipidus was confirmed if all of the following criteria were met: urine volume >50 cc kg(-1) d(-1), serum osmolarity >300 mmol/L, urine osmolarity <300 mmol/L, and serum sodium >145 mEq/L. The primary outcome was the incidence of CDI.
  
  
  RESULTS
  Of the 385 included patients, 45 (11.7%) had confirmed central CDI. Univariate analysis showed that younger age, nonwitness of collapse, nonshockable rhythm, a high incidence of asphyxia arrest, longer downtime, and lower initial core temperature were associated with CDI development. Patients with CDI had a higher incidence of poor neurologic outcomes at discharge and higher in-hospital mortality rate (20/45 vs 76/340, P= .001) as well as 180-day mortality (44/45 vs 174/340, P< .001). Multivariate analysis revealed that age (odds ratio [OR], 0.963; 95% confidence interval [CI], 0.942-0.984), shockable rhythm (OR, 0.077; 95% CI, 0.009-0.662), downtime (OR, 1.025; 95% CI, 1.006-1.044), and asphyxia etiology (OR, 6.815; 95% CI, 2.457-18.899) were independently associated with CDI development.
  
  
  CONCLUSIONS
  Central diabetes insipidus developed in 12% of cardiac arrest survivors treated with TTM, and those with CDI showed poor neurologic outcomes and high mortality rates. Younger age, nonshockable rhythm, long downtime, and asphyxia arrest were significant risk factors for development of CDI.
authors.affiliation: Department of Emergency Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, Republic of Korea.
authors.forename: Dong Hun
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, Republic of Korea. Electronic address: bbukkuk@hanmail.net.
authors.forename: Byung Kook
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, KS Hospital, 220, Wangbeodl-ro, Suwandong, Gwangsangu, Gwangju, Republic of Korea.
authors.forename: Kyoung Hwan
authors.initials: KH
authors.lastname: Song
authors.affiliation: Department of Emergency Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, Republic of Korea.
authors.forename: Yong Hun
authors.initials: YH
authors.lastname: Jung
authors.affiliation: Department of Emergency Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
authors.forename: Jung Soo
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, Republic of Korea.
authors.forename: Sung Min
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, Republic of Korea.
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Cho
authors.affiliation: Department of Radiology, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwanjgu, Republic of Korea.
authors.forename: Jin Woong
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, Republic of Korea.
authors.forename: Kyung Woon
authors.initials: KW
authors.lastname: Jeung
mesh_terms: D000328:Adult; D000368:Aged; D020790:Diabetes Insipidus, Neurogenic / Q000453:epidemiology / Q000209:etiology*; D019468:Disease Management; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors