Factors associated with serum electrolyte imbalances and unfavorable Outcome among Traumatic Brain injury Patients at Mbarara Regional Referral Hospital
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Date
2023-05
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Kampala International University
Abstract
Introduction: Electrolyte abnormalities have for long been a common observation among patients with brain lesions. Traumatic brain injury (TBI) is an important global public health concern. TBI patients with abnormal serum electrolytes show a delay in healing, increase in length of hospital stay (LOS) and a high mortality. Despite this, very few studies have been done on factors associated with this unfavorable outcome and none about electrolyte imbalances in Uganda. This study aimed at assessing the factors associated with serum electrolyte imbalances and unfavorable outcome among Traumatic Brain Injury patients at Mbarara Regional Referral Hospital (MRRH).
Methods: This study was partly cross-sectional and partly prospective cohort done at MRRH. TBI Patients aged 18-65 years admitted at MRRH were enrolled. Serum electrolytes were measured at admission and 48 hours later. The patients were followed up to discharge and extended Glasgow outcome score determined in addition to LOS. Analysis was done using SPSS version 22.
Results: During the study period, 254 patients with TBI were enrolled, majority of whom were males 226 (93.4%).Overall, 119(49.2%) patients had at least one electrolyte abnormality at one point during the study. The commonest electrolyte imbalances were hyponatremia and hyperchloremia. Hyponatremia at admission was independently associated with hyperthermia (AOR=2.531, CI=1.047-6.117, P=0.039) and being aged 46 years or above (AOR=2.784, CI= 1.006-7.706, P=0.049). Hypernatremia at admission was independently associated with being aged 45 years and (P=0.028, AOR=10.631, CI=1.288-67.747), Tachycardia at admission (P=0.011, AOR=14.642, CI=1.869-44.682) and hyperthermia at 48 hours (P=0.004, AOR=5.533, CI=1.321-18.620).Hyponatremia at 48 hours was independently associated with GCS < 13 at admission (AOR=3.671, CI=1.131-11.923, P=0.030).Hypernatremia at 48 hours was independently associated with age group 31-45 (P=0.023) and 46+ (P=0.027), bradycardia (P=0.019) and tachycardia (P=0.044) at admission, Low SPO2 at admission (p=0.001), Low SPO2 at 48 hours (P=0.014) and GCS 9-12 at 48 hours (P=0.025).Hypokalemia at admission was independently associated with systolic hypotension at admission (AOR=9.050, CI=1.477- 55.458, P=0.017). Hyperkalemia at admission was independently associated with systolic hypotension at admission (AOR=18.557, CI=1.973-74.513, P=0.011). Hypokalemia at 48 hours was independently associated with presenting after 24 hours (AOR=4.854, CI=1.046-22.523, P=0.044). Hyperkalaemia at 48 hours was independently associated with hypotension at 48 hours (P=0.035). Hypochloremia at admission was independently associated with hyperthermia at admission (AOR=6.847, CI=2.407-19.479, P=<0.001).Hyperchloremia at admission was independently associated with chronic alcohol use (P=0.031), presence of hypotension at admission (P=0.005), and presence of hyperthermia at 48 hours (P=0.047).Hypochloremia at 48hours was independently associated with having a GCS </=8 at 48 hours (AOR=7.900, CI=1.717-36.344, P=0.008).Hyperchloremia at 48hours was independently associated with GCS </=8 at admission (AOR=4.862, CI=1.575-15.007, P=0.006) and having hyperthermia at 48 hours (AOR=3.825, CI=1.261-11.604, P=0.018).Mortality was independently associated with age category 31-45 years (P=0.027), presentation after 24 hours (P=0.010), History of chronic alcohol intake (P=0.003), presence of hyperthermia at 48 hours (P=0.037) and GCS </=8 at 48 hours (P=0.003). GOSE 2-4 was independently associated with presentation after 24 hours (P=0.001), and hypoxia at 48 hours (P=0.006).Prolonged hospital stay was independently associated with presentation after 24 hours (P=0.025), tachycardia at admission (P=0.045), bradycardia at admission (P=0.049), GCS less than 13 (P<0.001), and low sodium at 48 hours (P=0.014).
Conclusion: The prevalence of electrolyte imbalances among TBI patients was high. Close monitoring of serum electrolytes should be done for patients 31 years and above, those with hyperthermia, tachycardia, GCS less than 13, bradycardia, hypoxia, hypotension, those presenting after 24 hours post injury, and chronic alcohol users. More Attention should be extended towards patients that present 24 hours after injury, those with hyperthermia, hypoxia, tachycardia and GCS less or equal to 13, any electrolyte imbalance like hyponatremia as these are associated with mortality, Glasgow coma scale extended sore of 2-4 and increased length of hospital stay.
Description
A research dissertation submitted in partial fulfillment of the requirements for the award of Degree of Master of Medicine in General Surgery of Kampala International University