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Hypozincaemia is associated with severity of aneurysmal subarachnoid haemorrhage: a retrospective cohort study

  • Original Article - Neurosurgical intensive care
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Abstract

Background

Hypozincaemia may develop in critically ill patients, including those with acute brain injury in the early phase after hospital admission. The aim of this study was to investigate the prevalence of hypozincaemia after aneurysmal subarachnoid haemorrhage (aSAH) and its association with delayed cerebral ischemia and functional outcome.

Methods

We retrospectively analysed a cohort of 384 patients with SAH admitted to the Neurointensive Care Unit at Rigshospitalet, Copenhagen, Denmark, in whom at least one measurement of plasma zinc concentration was done during the hospital stay. Hypozincaemia was defined as at least one measurement of plasma zinc below 10 μmol/L. Potential associations between hypozincaemia, demographic variables and functional outcome after aSAH were analysed in multivariable logistic regression models.

Results

Hypozincaemia was observed in 67% (n = 257) of all patients and occurred within 7 days in more than 95% of all hypozincaemic patients. In a multivariable model, severe SAH (WFNS 3–5; OR 4.2, CI 2.21–8.32, p < 0.001) and Sequential Organ Failure Assessment (SOFA) score on the day of admission (OR 1.24, CI 1.11–1.40, p < 0.001) were independently associated with hypozincaemia. In another multivariable model, hypozincaemia was independently associated with an unfavourable outcome (defined as a modified Rankin Scale score from 3 to 6) (OR 1.97, CI 1.06–3.68, p = 0.032), as was age (OR 1.03, CI 1.01–1.05, p = 0.015), SOFA score on the day of admission (OR 1.14, CI 1.02–1.29, p = 0.02), a diagnosis of delayed cerebral ischaemia (OR 4.06, CI 2.29–7.31, p < 0.001) and a clinical state precluding assessment for delayed cerebral ischaemia (OR 15.13, CI 6.59–38.03, p < 0.001).

Conclusion

Hypozincaemia occurs frequently after aSAH, is associated with a higher disease severity and independently contributes to an unfavourable outcome.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

Abbreviations

aSAH:

Aneurysmal subarachnoid haemorrhage

SOFA:

Sequential Organ Failure Assessment

BMI:

Body mass index

CI:

Confidence interval

OR:

Odds ratio

mRS:

Modified Rankin Scale

DCI:

Delayed cerebral ischaemia

NICU:

Neurointensive Care Unit

WFNS:

World Federation of Neurosurgical Societies

GCS:

Glasgow Coma Scale

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Acknowledgements

We would like to thank bioinformatician Jesper Qvist Thomassen, from the Department of Clinical Biochemistry Rigshospitalet, for his assistance regarding data extraction.

Authors’ contribution statements

TA, MHO, RFS and KM conceived the idea of the project. MO, RR, SB, VE and RFS delivered the data available. TA and MHO carried out the analytical methods. TA wrote the manuscript and was supervised by MHO and KM. All authors discussed the results and contributed to the final manuscript.

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Authors and Affiliations

  1. Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Tobias Arleth, Markus Harboe Olsen, Matias Orre, Søren Bache & Kirsten Møller

  2. Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark

    Rune Rasmussen & Vagn Eskesen

  3. Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Ruth Frikke-Schmidt

  4. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Ruth Frikke-Schmidt & Kirsten Møller

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  1. Tobias Arleth
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Correspondence to Tobias Arleth.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was performed by data extraction and analysis from patient charts, and therefore, for this type of study, approval by a Committee on Health Research Ethics and formal consent from patients or relatives was not required according to Danish law.

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Arleth, T., Olsen, M.H., Orre, M. et al. Hypozincaemia is associated with severity of aneurysmal subarachnoid haemorrhage: a retrospective cohort study. Acta Neurochir 162, 1417–1424 (2020). https://doi.org/10.1007/s00701-020-04310-z

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