Predictive Role of ICU-Acquired Hypernatremia and Sodium Fluctuation in the Diagnosis and Treatment of Sepsis
LI Hongqiang
WANG Zhenhua
Abstract：Objective To observe ICU-acquired hypernatremia and sodium fluctuation to explore their predictive value for the prognosis of patients with sepsis.Methods From March 2021 to March 2023,338 critically ill sepsis patients treated in the First Affiliated Hospital of Zhengzhou University.Based on serum sodium levels,patients were classified into three groups:non-hypernatremia group,ICU-acquired hypernatremia group,and admission hypernatremia group.All baseline data of the patients were collected,the serum sodium levels on the first day of admission and the highest blood sodium levels during the ICU stay were recorded,and the survival status of patients were documented.Restricted cubic spline analysis was used to examine the nonlinear relationship between maximum serum sodium and mortality.Kaplan-Meier curves were employed to evaluate the 30-day cumulative survival rate of patients.A multivariate logistic regression model assessed the independent risk factors for mortality in patients with sepsis.Subgroup and sensitivity analyses were conducted to determine the stability of the model.The receiver operating characteristic(ROC)analysis was used to determine the optimal cutoff value of sodium fluctuation for predicting clinical mortality.Results The mortality for the non-hypernatremic group,the ICU-acquired hypernatremia group,and the admission hypernatremia group were 22.4％,41.7％,and 34.1％,respectively(x2=12.190,P=0.002).A restricted cubic spline analysis indicated a linear association between the highest serum sodium levels and mortality(non-linearity P=0.608,overall P=0.007).Kaplan-Meier curves showed that patients with ICU-acquired hypernatremia and those with admission hypernatremia manifested an elevated mortality hazard relative to non-hypernatremia patients(log-rank P=0.037).In multivariable logistic regression analysis,hypernatremia displayed a marked correlation with heightened mortality among critically ill sepsis sufferers(OR:1.835,95％CI:1.058-3.185)within the entire cohort.Analogous outcomes were manifested in subgroup analysis and sensitivity analysis models.ROC curve analysis revealed that the optimal cutoff for serum sodium fluctuation to predict death in septic patients was 8.5 mmol·L-1,while the change in serum sodium greater than 8.5 mmol·L-1 significantly increased the mortality of patients(40.8％vs 22.3％,OR:2.273,95％CI:1.400-3.689,P=0.001).Conclusion Hypernatremia is independently associated with mortality in critically ill patients with sepsis.The optimal threshold for sodium fluctuation to predict clinical mortality in sepsis patients is 8.5 mmol·L-1.These results imply that hypernatremia may contribute to risk categorization and prompt intervention for critically ill patients suffering from sepsis.
Keywords：acquired hypernatremiaserum sodium fluctuationsepsismortalityintensive care unit
Publication Date：2026-06-13
Online Publishing Date：2026-09-12(First online date of this platform, not the publication date of the document)
Pages：6( 1921-1926 )