Risk factors of ICU acquired hypernatremia and its influence on prognosis of patients with septic shock_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Haixiang ¹ , WANG Yang ² , CHEN Jun ² , FAN Chunlei ² , ZHOU Hao ³ , QIAN Jiajie ⁴ , SHI Maiqing ² ,  WANG Xu ²

1. Department of Intensive Care Unit, Suzhou Industrial Park Xinghu Hospital, Suzhou, Jiangsu 215000, P. R. China;
2. Department of Central Intensive Care Unit of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P. R. China;
3. Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P. R. China;
4. Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P. R. China;

Corresponding?author：

WANG Xu, Email: 20224132152@stu.suda.edu.cn

Keywords：

ICU-acquired hypernatremia; septic shock; prognosis

DOI：

10.7507/1671-6205.202304019

Video：

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Objective To evaluate the effects of intensive care unit (ICU)-acquired hypernatremia (IAH) on the outcome of septic shock patients. Methods This retrospective study analyzed 116 septic shock patients admitted to the ICU of the First Affiliated Hospital of Soochow University from August 2018 to December 2022. Patients were divided into two groups: IAH group and normonatremia group. χ² test, t test and the Mann-Whitney U test of the non-parametric test were used to compare the differences in clinical data between the two groups. Independent risk factors for IAH were identified by unconditioned Logistic regression analysis, and receiver operating characteristic (ROC) curves were constructed to determine their role in predicting IAH. The Kaplan-Meier curve was used to evaluate the effects of IAH and its duration on 28-day survival. Results Renal insufficiency, K⁺ concentration, body temperature max, mechanical ventilation, chronic critical illness, rapid recovery, sepsis-associated encephalopathy, persistent inflammation, immunosuppression and catabolism syndrome, and the length of stay in ICU had significant differences (P<0.05). Multivariate logistic regression analysis showed: total urine volume in the previous 3 days [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.01 - 1.16, P=0.019] and sodium content in enteral nutrition preparations (670 mg) (OR 6.00, 95%CI 1.61 - 22.42, P=0.006) were independent risk factors for IAH. In addition, the area under the ROC curve of total urine output in the first 3 days was 0.800 (95%CI 0.678 - 0.922, P=0.001). Finally, the duration of IAH was significantly correlated with 28-day survival rate (P=0.020). Conclusions IAH is a common and serious complication in septic shock, and is the main cause of poor prognosis. Sodium status may act as an ideal screening tool for patients with septic shock.

Citation： WANG Haixiang, WANG Yang, CHEN Jun, FAN Chunlei, ZHOU Hao, QIAN Jiajie, SHI Maiqing, WANG Xu. Risk factors of ICU acquired hypernatremia and its influence on prognosis of patients with septic shock. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(8): 566-571. doi: 10.7507/1671-6205.202304019 Copy

1.	Singer M, Deutschman CS, Seymour CW, et al. The Third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 801-810.
2.	Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the global burden of disease study. Lancet, 2020, 395(10219): 200-211.
3.	Lin CY, Chen YM, Tsai YH, et al. Association of hypernatremia with immune profiles and clinical outcomes in adult intensive care unit patients with sepsis. Biomedicines. 2022, 10(9).
4.	Qi Z, Lu J, Liu P, et al. Nomogram prediction model of hypernatremia on mortality in critically ill patients. Infect Drug Resist, 2023, 16: 143-153.
5.	Chand R, Chand R, Goldfarb DS. Hypernatremia in the intensive care unit. Curr Opin Nephrol Hypertens, 2022, 31(2): 199-204.
6.	Rugg C, Strohle M, Treml B, et al. ICU-Acquired hypernatremia is associated with persistent inflammation, immunosuppression and catabolism syndrome. J Clin Med, 2020, 9(9): 3017.
7.	Wenstedt EF, Verberk SG, Kroon J, et al. Salt increases monocyte CCR2 expression and inflammatory responses in humans. JCI Insight, 2019, 4(21): e130508 .
8.	Binger KJ, Gebhardt M, Heinig M, et al. High salt reduces the activation of IL-4- and IL-13-stimulated macrophages. J Clin Invest, 2015, 125(11): 4223-4238.
9.	Flierl MA, Rittirsch D, Weckbach S, et al. Disturbances of the hypothalamic-pituitary-adrenal axis and plasma electrolytes during experimental sepsis. Ann Intensive Care. 2011, 1: 53.
10.	Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Am Fam Physician, 2015, 91(5): 299-307.
11.	Natochin YV, Golosova DV. Vasopressin receptor subtypes and renal sodium transport. Vitam Horm, 2020, 113: 239-258.
12.	汪濤. 腸內營養液滲透壓對其輔助治療大鼠潰瘍性結腸炎的影響. 蘇州大學, 2018.
13.	Xin Y, Tian M, Deng S, et al. The key drivers of brain injury by systemic inflammatory responses after sepsis: microglia and neuroinflammation. Mol Neurobiol, 2023, 60(3): 1369-1390.
14.	Bayat M, Gourabi H, Khammari A, et al. A comparative study of structure, stability and function of sc-tenecteplase in the presence of stabilizing osmolytes. J Biotechnol, 2018, 280: 1-10.
15.	Lee YI, Ahn J, Ryu JA. Clinical outcomes associated with degree of hypernatremia in neurocritically ill patients. J Korean Neurosurg Soc, 2023, 66(1): 95-104.
16.	Hourmant Y, Huard D, Demeure DLD, et al. Effect of continuous infusion of hypertonic saline solution on survival of patients with brain injury: a systematic review and meta-analysis. Anaesth Crit Care Pain Med, 2023, 42(2): 101177.

1. Singer M, Deutschman CS, Seymour CW, et al. The Third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 801-810.
2. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the global burden of disease study. Lancet, 2020, 395(10219): 200-211.
3. Lin CY, Chen YM, Tsai YH, et al. Association of hypernatremia with immune profiles and clinical outcomes in adult intensive care unit patients with sepsis. Biomedicines. 2022, 10(9).
4. Qi Z, Lu J, Liu P, et al. Nomogram prediction model of hypernatremia on mortality in critically ill patients. Infect Drug Resist, 2023, 16: 143-153.
5. Chand R, Chand R, Goldfarb DS. Hypernatremia in the intensive care unit. Curr Opin Nephrol Hypertens, 2022, 31(2): 199-204.
6. Rugg C, Strohle M, Treml B, et al. ICU-Acquired hypernatremia is associated with persistent inflammation, immunosuppression and catabolism syndrome. J Clin Med, 2020, 9(9): 3017.
7. Wenstedt EF, Verberk SG, Kroon J, et al. Salt increases monocyte CCR2 expression and inflammatory responses in humans. JCI Insight, 2019, 4(21): e130508 .
8. Binger KJ, Gebhardt M, Heinig M, et al. High salt reduces the activation of IL-4- and IL-13-stimulated macrophages. J Clin Invest, 2015, 125(11): 4223-4238.
9. Flierl MA, Rittirsch D, Weckbach S, et al. Disturbances of the hypothalamic-pituitary-adrenal axis and plasma electrolytes during experimental sepsis. Ann Intensive Care. 2011, 1: 53.
10. Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Am Fam Physician, 2015, 91(5): 299-307.
11. Natochin YV, Golosova DV. Vasopressin receptor subtypes and renal sodium transport. Vitam Horm, 2020, 113: 239-258.
12. 汪濤. 腸內營養液滲透壓對其輔助治療大鼠潰瘍性結腸炎的影響. 蘇州大學, 2018.
13. Xin Y, Tian M, Deng S, et al. The key drivers of brain injury by systemic inflammatory responses after sepsis: microglia and neuroinflammation. Mol Neurobiol, 2023, 60(3): 1369-1390.
14. Bayat M, Gourabi H, Khammari A, et al. A comparative study of structure, stability and function of sc-tenecteplase in the presence of stabilizing osmolytes. J Biotechnol, 2018, 280: 1-10.
15. Lee YI, Ahn J, Ryu JA. Clinical outcomes associated with degree of hypernatremia in neurocritically ill patients. J Korean Neurosurg Soc, 2023, 66(1): 95-104.
16. Hourmant Y, Huard D, Demeure DLD, et al. Effect of continuous infusion of hypertonic saline solution on survival of patients with brain injury: a systematic review and meta-analysis. Anaesth Crit Care Pain Med, 2023, 42(2): 101177.

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Risk factors of ICU acquired hypernatremia and its influence on prognosis of patients with septic shock

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