Prognostic impact of hypernatremia for septic shock patients in the intensive care unit

doi:10.12998/wjcc.v13.i7.95430

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World Journal of Clinical Cases

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World J Clin Cases. Mar 6, 2025; 13(7): 95430
Published online Mar 6, 2025. doi: 10.12998/wjcc.v13.i7.95430

Table 1 Baseline clinical characteristics, n (%)/mean ± SD/median (25^th-75^th percentiles)

Variable	IAH	Non-IAH	Normonatremia	P value
Variable	(n = 62)	(n = 41)	(n = 54)	P value
Age, years	66.20 ± 15.40	66.10 ± 16.90	65.30 ± 15.10	0.956
Sex (Female)	22 (35.48)	10 (24.39)	18 (33.33)	0.476
Comorbidities
Hypertension	31 (50.00)	23 (56.10)	24 (44.44)	0.530
Diabetes mellitus	16 (25.81)	9 (21.95)	10 (18.52)	0.611
CHD	4 (6.45)	1(2.44)	4 (7.41)	0.626
Cerebral infarction	10 (16.13)	6 (14.63)	3 (5.56)	0.186
SAE	20 (32.23)	24 (58.54)	13 (24.07)	0.002
Laboratory parameters
K⁺, mmol/L	3.89 ± 0.62	3.92 ± 0.83	4.17 ± 0.74	0.078
Ca²⁺, mmol/L	1.08 (1.04, 1.17)	1.08 (1.02, 1.20)	1.09 (1.06, 1.12)	0.895
Cl^-, mmol/L	102.85 (98.03, 106.03)	103.20 (98.50, 112.05)	100.30 (96.63, 104.03)	0.019
SCr, µmol/L	148.50 (91.30, 214.73)	116.80 (73.85, 190.10)	113.55 (72.00, 297.38)	0.524
BUN/SCr	216.23 (149.83, 264.87)	267.56 (194.18, 371.69)	185.06 (133.73, 250.25)	0.001
BUN, mmol/L	18.90 (11.15, 25.88)	20.81 (13.20, 29.55)	15.00 (11.43, 24.14)	0.185
ALB, g/L	26.23 ± 5.55	27.55 ± 3.71	27.52 ± 5.40	0.290
Serum prealbumin, mg/L	68.35 (50.55, 100.45)	63.40 (38.45, 86.55)	81.20 (63.68, 118.38)	0.042
PCT, ng/mL	11.29 (3.40, 50.00)	9.87 (3.18, 31.61)	14.58 (2.40, 34.00)	0.964
WBC, 10⁹/L	19.12 ± 11.12	18.47 ± 9.41	21.31 ± 11.34	0.387
CRP, mg/L	191.49 ± 92.02	206.49 ± 86.19	166.42 ± 84.56	0.083
Lym, 10⁹/L	0.34 (0.20, 0.53)	0.35 (0.20, 0.62)	0.40 (0.21, 0.63)	0.765
NT-proBNP, ng/L	2673 (806, 8020)	4221 (635, 14221)	3220 (912, 10625)	0.720
Myo, ng/mL	329 (146, 575)	706 (316, 1952)	259 (120, 630)	0.008
Body temperature max, °C	38.15 (37.40, 38.60)	37.80 (37.50, 38.40)	37.50 (37.20, 38.10)	0.017
Delirium	12 (19.35)	9 (21.95)	8 (14.81)	0.657
Interventions
MV	45 (72.58)	34 (82.93)	27 (50.00)	0.002
CRRT	24 (38.71)	18 (43.90)	18 (33.33)	0.573
Clinical scores
GCS score	6.00 (5.00, 10.00)	5.00 (3.00, 6.00)	6.50 (3.00, 9.75)	0.109
APACHE II score	17.49 ± 5.52	21.72 ± 6.40	16.38 ± 8.30	0.001
qSOFA score	1 (1, 2)	2 (1, 2)	2 (1, 2)	0.239
SOFA score	10.31 ± 3.98	10.64 ± 4.08	9.48 ± 5.41	0.444
SIRS	56 (90.32)	36 (87.80)	50 (92.59)	0.498
Pathogenic
G⁺ bacteria	7 (11.29)	2 (4.88)	10 (18.52)	0.126
G^- bacteria	31 (50.00)	29 (70.73)	19 (35.19)	0.003
Fungi	5 (8.06)	3 (7.32)	8 (14.81)	0.380
G⁺ and G^- bacteria, n (%)	4 (6.45)	1 (2.44)	2 (3.70)	0.594
G⁺ bacteria and fungi, n (%)	1 (1.61)	0 (0.00)	1 (1.85)	0.695
G^- bacteria and fungi	3 (4.84)	1 (2.44)	2 (3.70)	0.823
Time
ICU LOS, days	16.50 (8.75, 26.75)	12.00 (5.00, 25.50)	5.00 (2.00, 12.00)	< 0.001
LOS outside the ICU, days	0.00 (0.00, 9.00)	0.00 (0.00, 7.00)	2.00 (0.00, 11.25)	0.155
Died within 14 days	22 (35.48)	22 (53.66)	20 (37.04)	0.146

IAH: ICU-acquired hypernatremia; ICU: Intensive care unit; CHD: Coronary heart disease; SAE: Sepsis-associated encephalopathy; SCr: Serum creatinine; BUN/SCr: Urea-to-creatinine ratio; BUN: Blood urea nitrogen; ALB: Serum albumin; PCT: Procalcitonin; WBC: White blood cell counts; CRP: C-reactive protein; Lym: Lymphocytes; NT-proBNP: N-terminal pro-B-type natriuretic peptide; Myo: Myoglobin; MV: Mechanical ventilation; CRRT: Continuous renal replacement therapy; GCS: Glasgow coma scale; APACHE II: Acute physiology and chronic health evaluation II; qSOFA: Quick sequential organ failure assessment; SOFA: Sequential organ failure assessment; SIRS: Systemic inflammatory response syndrome; LOS: Length of stay.

Table 2 Univariate analysis for risk factors of intensive care unit-acquired hypernatremia in septic shock patients, n (%)/mean ± SD

	IAH	Normonatremia	Univariate	P value
	(n = 62)	(n = 54)	OR (95%CI)	P value
Diabetes mellitus	17 (27.42)	10 (18.52)	1.66 (0.69-4.03)	0.26
Kidney insufficiency	3 (4.84)	10 (18.52)	0.22 (0.06-0.86)	0.029
Body temperature max, °C	38.15 (37.40-38.60)	37.50 (37.20-38.10)	1.17 (0.85-1.60)	0.348
Urine volume, ml
1^st + 2^nd + 3^rd	5775.00 (2908.75-7512.50)	3730.00 (257.50, 5732.50)	1.10 (1.04-1.17)	0.002
The sodium content of EN
315 mg	13 (20.97)	7 (12.96)	1.78 (0.65-4.85)	0.259
500 mg	26 (41.94)	10 (18.52)	3.18 (1.36-7.45)	0.008
670 mg	19 (30.65)	4 (7.41)	5.52 (1.74-17.49)	0.004
Diuretic	43 (69.35)	26 (48.15)	2.44 (1.14-5.21)	0.021
Mannitol	8 (12.90)	4 (7.41)	1.85 (0.53-6.53)	0.338
Glucocorticoids	37 (59.68)	27 (50.00)	1.48 (0.71-3.09)	0.296
Blood glucose max, mmol/L	10.86 ± 3.62	9.73 ± 3.51	1.09 (0.98-1.22)	0.095
CRP, mg/L	191.49 ± 92.02	166.42 ± 84.56	1.00 (1.00-1.01)	0.135
Lym, 10⁹/L	0.34 (0.20, 0.53)	0.39 (0.21, 0.62)	0.71 (0.31-1.62)	0.419
Serum prealbumin, mg/L	68.35 (50.55, 100.45)	81.20 (63.68, 118.38)	0.99 (0.98-1.00)	0.073
ALB, g/L	26.23 ± 5.55	27.52 ± 5.40	0.96 (0.89-1.03)	0.209
BUN, mmol/L	18.90 (11.15, 25.88)	15.00 (11.43, 24.14)	1.00 (0.98-1.03)	0.833
BUN/SCr	227.44 ± 117.94	198.05 ± 90.72	1.00 (1.00-1.01)	0.144
APACHE II score	17.49 ± 5.52	16.38 ± 8.30	1.02 (0.97-1.08)	0.402
SOFA score	10.31 ± 3.98	9.48 ± 5.41	1.04 (0.96-1.13)	0.356
SIRS, n (%)	58 (93.55)	52 (96.30)	0.56 (0.10-3.17)	0.51

IAH: ICU-acquired hypernatremia; ICU: Intensive care unit; OR: Odd ratio; EN: Enteral nutrition; CRP: C-reactive protein; Lym: Lymphocytes; ALB: Serum albumin; BUN: Blood urea nitrogen; BUN/SCr: Urea-to-creatinine ratio; APACHE II: Acute physiology and chronic health evaluation II; SOFA: Sequential organ failure assessment; SIRS: Systemic inflammatory response syndrome.

Table 3 Multivariate analysis for independent risk factors of intensive care unit-acquired hypernatremia in septic shock patients, n (%)

	IAH	Normonatremia	Multivariate	P value
	(n = 62)	(n = 54)	OR (95%CI)	P value
Kidney insufficiency	3 (4.84)	10 (18.52)	0.37 (0.08-1.67)	0.197
Urine volume, ml
1^st + 2^nd + 3^rd	5775 (2908.75, 7512.5)	3730 (257.5, 5732.5)	1.09 (1.02-1.17)	0.014
The sodium content of EN
500 mg	26 (41.94)	10 (18.52)	2.93 (1.13-7.60)	0.027
670 mg	19 (30.65)	4 (7.41)	6.19 (1.75-21.98)	0.005
Diuretics-	43 (69.35)	26 (48.15)	1.87 (0.78-4.47)	0.159

IAH: ICU-acquired hypernatremia; ICU: Intensive care unit; OR: Odd ratio; EN: Enteral nutrition.

Table 4 Areas under the receiver operator curves presented of predicting intensive care unit-acquired hypernatremia

Variable	AUC	95%CI	P value
Urine volume 1^st + 2^nd + 3^rd	0.80	0.68-0.92	0.001
Urine volume 1^st	0.75	0.60-0.90	0.008
Urine volume 2^nd	0.77	0.63-0.91	0.004
Urine volume 3^rd	0.78	0.65-0.91	0.003
The sodium content of EN	0.60	0.43-0.78	0.274

AUC: Areas under the curve; ROC: Receiver operator curves; EN: Enteral nutrition.

Citation: Shi MQ, Chen J, Ji FH, Zhou H, Peng K, Wang J, Fan CL, Wang X, Wang Y. Prognostic impact of hypernatremia for septic shock patients in the intensive care unit. World J Clin Cases 2025; 13(7): 95430
URL: https://www.wjgnet.com/2307-8960/full/v13/i7/95430.htm
DOI: https://dx.doi.org/10.12998/wjcc.v13.i7.95430