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Incidence and Effect of Diabetes Insipidus in the Acute Care of Patients with Severe Traumatic Brain Injury

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Abstract

Background

Literature on diabetes insipidus (DI) after severe traumatic brain injury (TBI) is scarce. Some studies have reported varying frequencies of DI and have showed its association with increased mortality, suggesting it as a marker of poor outcome. This knowledge gap in the acute care consequences of DI in severe TBI patients led us to conceive this study, aimed at identifying risk factors and quantifying the effect of DI on short-term functional outcomes and mortality.

Methods

We assembled a historic cohort of adult patients with severe TBI (Glasgow Coma Scale ≤ 8) admitted to the intensive care unit (ICU) of a tertiary-care university hospital over a 6-year period. Basic demographic characteristics, clinical information, imaging findings, and laboratory results were collected. We used logistic regression models to assess potential risk factors for the development of DI, and the association of this condition with death and unfavorable functional outcomes [modified Rankin scale (mRS)] at hospital discharge.

Results

A total of 317 patients were included in the study. The frequency of DI was 14.82%, and it presented at a median of 2 days (IQR 1–3) after ICU admission. Severity according to the Abbreviated Injury Scale (AIS) score of the head, intracerebral hemorrhage, subdural hematoma, and skull base fracture was suggested as risk factors for DI. Diagnosis of DI was independently associated death (OR 4.34, CI 95% 1.92–10.11, p = 0.0005) and unfavorable outcome (modified Rankin Scale = 4–6) at discharge (OR 7.38; CI 95% 2.15–37.21, p = 0.0047).

Conclusions

Diabetes insipidus is a frequent and early complication in patients with severe TBI in the ICU and is strongly associated with increased mortality and poor short-term outcomes. We provide clinically useful risk factors that will help detect DI early to improve prognosis and therapy of patients with severe TBI.

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Acknowledgments

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Funding

This research received no specific grant from any funding agency. The study was conducted with resources destined for research at our institution (Centro de Investigaciones Clínicas at Fundación Valle del Lili).

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Fundación Valle del Lili, Carrera 98 #18-49, Cali, Colombia

    Andrés Gempeler, Juan D. Aristizabal-Mayor & Jorge H. Mejia-Mantilla

  2. Faculty of Medicine, Universidad ICESI, Cali, Colombia

    Andrés Gempeler, Eduardo Orrego-González, Andrés Hernandez-Casanas & Jorge H. Mejia-Mantilla

  3. Centro de Investigaciones Clínicas, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, Colombia

    Andrés Gempeler, Andrés M. Castro & Juan D. Aristizabal-Mayor

Authors
  1. Andrés Gempeler
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  2. Eduardo Orrego-González
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  3. Andrés Hernandez-Casanas
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  4. Andrés M. Castro
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  6. Jorge H. Mejia-Mantilla
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Contributions

AG contributed to Protocol and project development, data collection and management, data analysis, manuscript writing and editing. EOG and AHC contributed to Protocol development, data collection, data Analysis, manuscript writing. AMC contributed to Protocol development, data analysis, manuscript editing. JDAM contributed to Protocol/project development, data collection and management, data analysis, manuscript editing. JHMM contributed to Protocol/project development, data management, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Jorge H. Mejia-Mantilla.

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The authors declare that they have no conflict of interest.

Ethical Approval/Informed Consent

Our institutional Research Ethics Committee approved our study protocol, the participation of each author, and oversaw study conduction. No informed consent was required for this study.

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Gempeler, A., Orrego-González, E., Hernandez-Casanas, A. et al. Incidence and Effect of Diabetes Insipidus in the Acute Care of Patients with Severe Traumatic Brain Injury. Neurocrit Care 33, 718–724 (2020). https://doi.org/10.1007/s12028-020-00955-x

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  • DOI: https://doi.org/10.1007/s12028-020-00955-x

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