Li Hangyang, Zhou Qiongli, Nan Yuyu, Liu Chengwei, Zhang Yun
Department of Critical Care Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University.
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University.
Tohoku J Exp Med. 2025 Mar 20;265(3):123-134. doi: 10.1620/tjem.2024.J091. Epub 2024 Sep 12.
The purpose of this project was to characterize the longitudinal dynamic serum sodium trajectory of sepsis patients with lactic acidosis (LA) admitted to the intensive care unit (ICU), and to explore the association between these trajectories and the 30-day mortality rate of patients. Data on patients admitted to the ICU with a diagnosis of LA combined with sepsis from 2008-2019 were collected from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Patients admitted to the ICU for > 24 hours and for the first time were sorted into 3 groups based on their serum sodium levels at admission. The Group-based Trajectory Modeling (GBTM) method was applied to analyze the trajectory changes of serum sodium in each group of patients over 72 hours. Patients' survival differences between different trajectory groups were compared using Kaplan-Meier (K-M) survival curves. Subgroup analysis was carried out to determine the influencing factors of the relationship between dynamic changes in serum sodium and patient survival. This study included 514 patients with LA complicated by sepsis, who were clustered into three groups based on their admission serum sodium levels, with 378 patients in the normal blood sodium (135-145 mEq/L) group, 116 patients in the hyponatremia (< 135 mEq/L) group, and 20 patients in the hypernatremia (> 145 mEq/L) group. GBTM analysis generated three different serum sodium trajectories. The K-M curve results demonstrated that patients with relatively stable serum sodium levels within the normal range (Class 2) had lower 30-day mortality compared to groups with larger fluctuations in sodium levels (Class 1, Class 3). Subgroup analysis uncovered notable interactions (P < 0.05) between different trajectories of serum sodium and covariates such as race, marital status, Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA), renal replacement therapy (RRT), congestive heart failure, kidney disease, liver disease, and diabetes. Among patients with LA complicated by sepsis, those with stable and normal fluctuations in serum sodium levels had better 30-day survival rates. GBTM is a refined method to describe the evolution of serum sodium and its association with clinical outcomes, which may enhance the current understanding of blood sodium level regulation.
本项目的目的是描述入住重症监护病房（ICU）的合并乳酸酸中毒（LA）的脓毒症患者血清钠水平的纵向动态变化轨迹，并探讨这些轨迹与患者30天死亡率之间的关联。从重症监护医学信息数据库-IV（MIMIC-IV）中收集了2008年至2019年入住ICU且诊断为LA合并脓毒症患者的数据。将首次入住ICU超过24小时的患者根据入院时的血清钠水平分为3组。应用基于组的轨迹建模（GBTM）方法分析每组患者72小时内血清钠的轨迹变化。使用Kaplan-Meier（K-M）生存曲线比较不同轨迹组患者的生存差异。进行亚组分析以确定血清钠动态变化与患者生存关系的影响因素。本研究纳入了514例合并脓毒症的LA患者，根据入院时血清钠水平分为三组，血钠正常（135-145 mEq/L）组378例，低钠血症（<135 mEq/L）组116例，高钠血症（>145 mEq/L）组20例。GBTM分析产生了三种不同的血清钠轨迹。K-M曲线结果表明，与钠水平波动较大的组（第1类、第3类）相比，血钠水平在正常范围内相对稳定的患者（第2类）30天死亡率较低。亚组分析发现血清钠不同轨迹与种族、婚姻状况、格拉斯哥昏迷量表（GCS）、序贯器官衰竭评估（SOFA）、肾脏替代治疗（RRT）、充血性心力衰竭、肾脏疾病、肝脏疾病和糖尿病等协变量之间存在显著交互作用（P<0.05）。在合并脓毒症的LA患者中，血清钠水平波动稳定且正常的患者30天生存率更高。GBTM是一种描述血清钠演变及其与临床结局关联的精细方法，可能会增进目前对血钠水平调节的理解。
