Serum Sodium: A Reliable and Validated Predictor for Mortality in Enteric Fistula Patients Complicated with Sepsis

ABSTRACT

Purpose: The aim was to evaluate the predictive value of serial serum sodium determination for mortality in enteric fistula (EF) patients complicated with sepsis. Methods: Between January 1^st, 2012 to January 13^th, 2013, we performed a prospective observational study enrolling 162 patients. Patients were divided into survivors group (n = 119) and nonsurvivors group (n = 43) according to 28-day outcomes. Laboratory variables on day 0, day 3, and day 7 after admission were recorded. [Na⁺]₀ was defined as serum [Na⁺] value on admission. [Na⁺]₃ was defined as serum [Na⁺] value on day 3. Δ [Na⁺]₃ was defined as changes from [Na⁺]₃ to [Na⁺]₀. The definition applied to other parameters_. The results were validated in an independent cohort of 116 patients. Results: ROC analysis showed that [Na⁺]₇>147.5 mmol/L and ΔNa₇>5.2 mmol/L were reliable predictors ([Na⁺]₇: 81.2% sensitivity, 87.7% specificity, (area under the curve(AUC):0.872, p < .001; Δ[Na⁺]₇: 81.3% sensitivity, 83.6% specificity, AUC:0.836, p < .001) for mortality. The combination form ([Na⁺]₇>147.5 mmol/L+ Δ[Na]₇>5.2 mmol/L+ ΔPCT₇<5.3 ng/ml) had greatest predictive value (AUC:0.899, p < .001). Their predictive values were confirmed in the validation cohort. Conclusions: Serum sodium was a reliable predictor for mortality in abdominal septic patients, which should be paid close attention in the critical care.

Keywords: :

• hypernatremia
• predictor
• biomarker
• enteric fistula
• abdominal sepsis