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Research Snapshot Theater: Neuroscience/Trauma, Adult

Hypernatremia in Acute Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Tuesday, March 24, 2026
8:45 AM - 9:45 AM Central Time
Location: Connections Central - RST 06
First Author: Ricardo O. Massoud, n/a
Co-Author: João S. Correia, n/a – Medical Student, University of South Florida
Co-Author: Mariana M. M Salles, N/A – Medical Student, Universidade do Oeste Paulista
Co-Author: Pedro L. Carvalho, N/A – Medical Student, Universidade Federal de Juiz de Fora


Introduction: Traumatic brain injury (TBI) may impair sodium regulation due to hypothalamic-pituitary axis dysfunction, potentially leading to hypernatremia. This sodium imbalance has been associated with adverse outcomes in critically ill patients. We conducted a systematic review and meta-analysis to assess whether hypernatremia in TBI is associated with worse clinical outcomes compared to normal or low sodium levels.


Methods: A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify observational studies comparing outcomes in TBI patients with hypernatremia versus normonatremia or hyponatremia. Outcomes included mortality, intensive care unit (ICU) length of stay (LOS), and hospital LOS. Data were pooled using random-effects models, and results were presented as odds ratios (OR) or mean differences with 95% confidence intervals (CI). Risk of bias was assessed using the ROBINS-I tool.


Results: Eight observational studies were included, involving 93,696 patients, of whom 5,559 developed hypernatremia. Hypernatremia was significantly associated with increased mortality (OR: 1.59; 95% CI: 1.17–2.17; P = 0.01). No significant differences were observed in ICU LOS (mean difference: 1.07 days; 95% CI: –2.09 to 4.24; P = 0.36) or hospital LOS (mean difference: 1.31 days; 95% CI: –24.14 to 26.77; P = 0.84). Sensitivity analysis for ICU LOS showed that excluding one study yielded a significant result (OR: 2.40; 95% CI: 1.29–3.50; P = 0.01). All studies had a moderate risk of bias.


Conclusions: Hypernatremia in patients with TBI is associated with increased mortality. However, evidence for its impact on ICU and hospital LOS remains inconclusive. Further studies are warranted to better understand the prognostic implications of hypernatremia in this population.