Analysis Of Risk Factors In Patients With Septic Shock With Hypernatremia And Their Impact On Prognosis

Objective:In this study,we aimed to investigate the risk factors for combined hypernatremia in patients with septic shock and to compare the prognostic differences in patients with septic shock with or without hypernatremia.The extent to which hypernatremia affects the prognosis of patients with septic shock was analyzed by clinical data.To provide clinical diagnostic aids for early identification of patients with high-risk septic shock,to improve the patient’s outcome and prognosis,and to reduce mortality in patients with septic shock.Methods:We collected patients admitted to the central ICU of the First Hospital of Soochow University for septic shock from January 2017 to March 2022.The inclusion criteria for septic shock were determined according to the third international consensus definition of sepsis and septic shock in 2016 and the 2016 international guidelines for the management of sepsis and septic shock.Hypernatremia was defined as two consecutive serum Na+concentrations>145 mmol/L to avoid laboratory error.Demographic indicators were collected,and laboratory indicators and clinical characteristics and mortality were recorded during the patients’ hospitalization.For risk factors of hypernatremia,univariate logistic regression analysis was performed for different indicators;p-values<0.05 were considered statistically significant,and further stepwise regression methods were used in multiple logistic regression analysis to test for statistically significant clinical indicators.In addition,KM survival curves were plotted to compare the mortality rate within 60 days between the two groups,and the impact of plasma marker levels on other secondary endpoint outcomes was analyzed using Spearman correlation analysis.Results:Hypernatremia occurred in 96 of 152 patients(63.16%)during their ICU stay.History of renal insufficiency,lymphocyte count,24-h urine output,albumin,and CRP levels were shown to be independent risk factors for the development of hypernatremia in patients with septic shock.The median survival time of patients with septic shock with hypernatremia was significantly shorter than that of patients in the non-hyper sodium group.In addition,hypernatremia was strongly associated with the development of chronic critical illness or rapid recovery,prolonged mechanical ventilation,and prolonged ICU stay with total length of stay in patients with septic shock in the ICU.And patients with severe hypernatremia were more likely to have a prolonged ICU stay compared to mild and moderate,yet patients with hypernatremia lasting<3 days had a high mortality rate.Conclusion:History of renal insufficiency,lymphocyte count,24-h urine volume,albumin,and CRP levels were independent risk factors for the development of hypernatremia in patients with septic shock in the ICU.In patients with septic shock,the median survival was significantly shorter in patients with hypernatremia compared with those without hypernatremia.In addition,concomitant hypernatremia was correlated with the development of chronic critical illness,the duration of mechanical ventilation in the ICU,and the duration of ICU stay and total hospital stay,which reduced the quality of patient survival to some extent;however,the severity of hypernatremia did not have a significant effect on patient mortality,and its occurrence was not clear.The reasons for its occurrence are unclear.Therefore,it is important to study the pathogenesis and clinical manifestations of hypernatremia in ICU patients to prevent the occurrence of hypernatremia,determine the course of hypernatremia earlier,reduce the mortality rate of patients,and improve the prognosis of patients.