Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2025; 13(7): 95430
Published online Mar 6, 2025. doi: 10.12998/wjcc.v13.i7.95430
Prognostic impact of hypernatremia for septic shock patients in the intensive care unit
Mai-Qing Shi, Jun Chen, Fu-Hai Ji, Hao Zhou, Ke Peng, Jun Wang, Chun-Lei Fan, Xu Wang, Yang Wang
Mai-Qing Shi, Jun Chen, Fu-Hai Ji, Ke Peng, Chun-Lei Fan, Xu Wang, Yang Wang, Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Hao Zhou, Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Jun Wang, Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Co-first authors: Mai-Qing Shi and Jun Chen.
Co-corresponding authors: Xu Wang and Yang Wang.
Author contributions: Shi MQ, Wang X contributed to data curation, formal analysis, visualization; Wang Y, Ji FH contributed to conceptualization; Zhou H, Peng K, Wang J contributed to writing-original draft; Chen J, Fan CL writing-review and editing.
Supported by The National Natural Science Foundation of China, No. 82072130; Key Medical Research Projects in Jiangsu Province, No. ZD2022021; and Suzhou Clinical Medical Center for Anesthesiology, No. Szlcyxzxj202102.
Institutional review board statement: The study was conducted in accordance with the declaration of Helsinki. The First Affiliated Hospital of Soochow University’s Institutional Review Board approved this study (approval number: 2023.228).
Informed consent statement: Written informed consent from the patients was not required to participate in this study in accordance with the national legislation and the institutional requirements.
Conflict-of-interest statement: The author(s) declare no conflict of interest relevant to the preparation of this manuscript.
Data sharing statement: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yang Wang, Doctor, Department of Anesthesiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, Jiangsu Province, China. sdfyyzxicu@sina.com
Received: April 10, 2024
Revised: October 4, 2024
Accepted: November 13, 2024
Published online: March 6, 2025
Processing time: 229 Days and 3 Hours
Abstract
BACKGROUND

Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes, particularly in cases of intensive care unit (ICU)-acquired hypernatremia (IAH). Nevertheless, its relevance in patients with septic shock remains uncertain.

AIM

To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.

METHODS

In the present retrospective single-center study, a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University, between August 1, 2018, and May 31, 2023, were analyzed. Patients were categorized based on the timing of hypernatremia occurrence into the IAH group (n = 62), the non-IAH group (n = 41), and the normonatremia group (n = 54).

RESULTS

In the present study, there was a significant association between the high serum sodium concentrations, excessive persistent inflammation, immunosuppression and catabolism syndrome and chronic critical illness, while rapid recovery had an apparent association with normonatremia. Moreover, multivariable analyses revealed the following independent risk factors for IAH: Total urinary output over the preceding three days [odds ratio (OR) = 1.09; 95%CI: 1.02–1.17; P = 0.014], enteral nutrition (EN) sodium content of 500 mg (OR = 2.93; 95%CI: 1.13–7.60; P = 0.027), and EN sodium content of 670 mg (OR = 6.19; 95%CI: 1.75–21.98; P = 0.005) were positively correlated with the development of IAH. Notably, the area under the curve for total urinary output over the preceding three days was 0.800 (95%CI: 0.678–0.922, P = 0.001). Furthermore, maximum serum sodium levels, the duration of hypernatremia, and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients (P < 0.05).

CONCLUSION

The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU. It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.

Keywords: Hypernatremia; Hypernatremia acquired in the intensive care unit; Septic shock; Persistent inflammation; Immunosuppression; Catabolism syndrome; Chronic critical illness; Prognosis

Core Tip: The aim of the present observational study was to improve outcomes in patients with septic shock by identifying independent risk factors and their predictive efficacy for intensive care unit-acquired hypernatremia. Additionally, the present findings indicate a significant association between the prognosis of septic shock patients and variables such as peak serum sodium levels, duration of hypernatremia, and differing rates of sodium correction. As such, the present authors propose that hypernatremia may serve as a critical predictive marker for the prognosis of septic shock.