Early central diabetes insipidus: An ominous sign in post-cardiac arrest patients

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• 作者：Minjung Kathy Chae ; Jeong Hoon Lee ; Tae Rim Lee ; Hee Yoon ; Sung Yeon Hwang ; Won Chul Cha ; Tae Gun Shin ; Min Seob Sim ; ^{coldco2@naver.com" class="auth_mail" title="E-mail the corresponding author} ; Ik Joon Jo ; Keun Jeong Song ; Joong Eui Rhee ; Yeon Kwon Jeong
• 关键词：Central diabetes insipidus ; Hypernatremia ; Therapeutic hypothermia ; Cardiac arrest ; Post&ndash ; cardiac arrest care
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：32
• 期：Complete
• 页码：63-67
• 全文大小：340 K

文摘

Central diabetes insipidus (CDI) after cardiac arrest is not well described. Thus, we aim to study the occurrences, outcomes, and risk factors of CDI of survivors after out-of-hospital cardiac arrest (OHCA).

Materials and methods

We retrospectively analyzed post-OHCA patients treated at a single center. Central diabetes insipidus was retrospectively defined by diagnostic criteria. One-month cerebral performance category (CPC) scores were collected for outcomes.

Results

Of the 169 patients evaluated, 36 patients (21.3%) were diagnosed with CDI. All CDI patients had a poor neurologic outcome of either CPC 4 (13.9%) or CPC 5 (86.1%), and CDI was strongly associated with mortality. Age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93-0.99), respiratory arrest (OR, 6.62; 95% CI, 1.23-35.44), asphyxia (OR, 9.26; 95% CI, 2.17-34.61), and gray to white matter ratio on brain computed tomogram (OR, 0.88; 95% CI, 0.81-0.95) were associated with the development of CDI. The onset of CDI was earlier (P < .001) and the maximum 24-hour urine output was larger (P = .03) in patients with worst outcomes.

Conclusions

All patients diagnosed with CDI had poor neurologic outcomes, and occurrence of CDI was associated with mortality. Central diabetes insipidus patients with death or brain death had earlier occurrence of CDI and more maximum urine output.