Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Ann Palliat Med. 2021 Apr;10(4):4705-4715. doi: 10.21037/apm-21-792.
Septic acute kidney injury (AKI), identified when sepsis and AKI present concurrently, is a syndrome of acute function impairment and organ damage, which accounts for ~50% AKI in the intensive care unit (ICU).
This study retrospectively reviewed 591 patients who were diagnosed with sepsis and admitted to the ICU of Beijing Friendship Hospital from January 2009 to December 2014. According to the concentration of serum sodium, the 591 patients were further divided into 3 groups: normal group, hyponatremia group, and hypernatremia group.
The arterial partial pressure of carbon dioxide (PaCO2, P=0.014), concentration of sodium (Na+, P<0.001), and chloride ion (Cl-, P<0.001), blood urea nitrogen (BUN, P<0.001), acute physiology and chronic health evaluation (APACHE) score (P<0.001), sequential organ failure assessment (SOFA) score (P<0.001), and Glasgow score (P<0.001) showed significant differences. The SOFA score [P=0.040; odds ratio (OR) =1.261], body mass index (BMI, P=0.041; OR =1.229), P content (P=0.032; OR =7.180) and creatine kinase myocardial band (CK-MB, P=0.006; OR =1.168) may be risk factors for occurrence of AKI in patients with hypernatremia. The AKI (P<0.001; OR =6.850) and P content (P=0.027; OR =3.676) may be risk factors for death in patients with hypernatremia. The Na+ suggested a predictive ability for AKI (P<0.001; area under the curve (AUC): 0.586) but not for death (P=0.104).
Hypernatremia is independently associated with an increased risk and has a predictive ability of AKI in patients with sepsis.
脓毒症合并急性肾损伤（AKI）是一种急性功能障碍和器官损伤的综合征，占 ICU 中 AKI 的 50%左右。
本研究回顾性分析了 2009 年 1 月至 2014 年 12 月期间在北京友谊医院 ICU 住院的 591 例脓毒症患者。根据血清钠浓度，将 591 例患者进一步分为 3 组：正常组、低钠血症组和高钠血症组。
动脉血二氧化碳分压（PaCO2，P=0.014）、钠浓度（P<0.001）、氯离子浓度（P<0.001）、血尿素氮（BUN，P<0.001）、急性生理学和慢性健康评估（APACHE）评分（P<0.001）、序贯器官衰竭评估（SOFA）评分（P<0.001）和格拉斯哥昏迷评分（P<0.001）差异有统计学意义。SOFA 评分[P=0.040；比值比（OR）=1.261]、体重指数（BMI，P=0.041；OR=1.229）、磷含量（P=0.032；OR=7.180）和肌酸激酶心肌带（CK-MB，P=0.006；OR=1.168）可能是高钠血症患者 AKI 发生的危险因素。AKI（P<0.001；OR=6.850）和磷含量（P=0.027；OR=3.676）可能是高钠血症患者死亡的危险因素。Na+提示 AKI 的预测能力（P<0.001；曲线下面积（AUC）：0.586），但对死亡无预测能力（P=0.104）。
高钠血症与脓毒症患者 AKI 的风险增加独立相关，并具有预测能力。
