Predictive Value Of The Corrected Serum Sodium Concentration In Hyperglycemic Hyperosmolar Syndrome

Objective To explore the predictive value of the corrected serum sodium concentration in hyperglycemic hyperosmolar syndrome（HHS）.Methods Query the medical record system of the Third Affiliated Hospital of Anhui Medical University,input the collected case data using Epi Data 3.1 software,and establish a database.According to the blood glucose and osmotic pressure standards for HHS diagnosis in the 2020 Guidelines for the Prevention and Treatment of Type 2diabetes in China,a total of 175 patients were selected to meet the requirements of this study,including 31 patients with hyperglycemic hypertonic syndrome and 144 patients with the hyperglycemic non-hypertonic syndrome.Collect the clinical data of all patients in this study,including general information such as gender,age,duration of diabetes,type of diabetes,laboratory test indicators for example admission random blood glucose,glycated hemoglobin A_lc,blood urea nitrogen,blood creatinine,blood potassium,blood sodium,effective plasma osmolality.Calculating the corrected sodium,according to the formula recommended by the 2020 Guidelines for the Prevention and Treatment of Type 2 diabetes in China:the corrected sodium=measured Na（mmol/L）+1.6×（mmol/L blood glucose（mmol/L）-5.6）/5.6.And calculate the difference values between corrected sodium and measured sodium（Δ[Na]）.Based on normal serum tonicity,175 patients were divided into hyperglycemic hypertonic group and hyperglycemic non-hypertonic group.The clinical data of the two groups were compared.Taking the median blood glucose at admission as the cutting point,the hyperglycemia hyperosmolar group and the hyperglycemia non-hyperosmolar group were divided into two groups,the hyperosmolar hyperglycemia group（16 cases）and hyperosmolar hypoglycemia group（15 cases）.The non-hypertonic hyperglycemia group（72 cases）and non-hypertonic hypoglycemia group（72 cases）.The general data,sodium,the corrected sodium concentration,the difference between the corrected sodium concentration and sodium,and prognosis（mortality）of the four groups were statistically analyzed,and the differences of variables among the groups were compared.Results1.Comparison of clinical indicators in HHS and n HHS groupsThere were 31 patients in the HHS group,of which 58.06%（18 cases）were male and 41.94%（13 cases）were female.The mean age of patients in the HHS group was 62.56±19.48 years old（range:21-94 years old）,which was higher than that in the n HHS group（P<0.05）.BUN,SCr,Na,corrected sodium,Δ[Na],and the serum tonicity in the HHS group was higher than those in the n HHS group（P<0.05）.2.Intra-group comparison of hyperglycemia hyperosmolar groupCompared with the HHS hypoglycemia group,BUN,SCr,K,and Glu in the HHS hyperglycemia group were higher（P<0.05）.Compared with the hyperosmolar hypoglycemia group,the difference between corrected sodium and measured sodium（Δ[Na]）in the hyperosmolar hyperglycemia group was higher（P<0.001）, and the number of deaths（prognosis is worse）in the hyperosmolar hyperglycemia group was higher（P<0.05）.The mean value of sodium in the hyperosmolar hyperglycemia group and the hyperosmolar hypoglycemia group[149.63±7.53 vs 154.99±8.07,P=0.065],and the mean value of Na in the two groups was higher than the normal range of blood sodium（135--145 mmol/L）.The corrected sodium in the two groups[158.75±7.32 vs 159.90±7.94,P=0.677).HHS（n=31）8 patients died during hospitalization（mortality 25.8%）,including 7 patients in the high blood glucose level group（87.5%）and 1 patient in the low blood glucose level group （12.5%）.3.Intra-group comparison of hyperglycemia non-hyperosmolar groupCompared with the n HHS hypoglycemia group,SCr,K,and Glu in the n HHS hyperglycemia group were significantly different（P<0.05）.Compared with the non-hypertonic hypoglycemia group,in the hyperosmolar hyperglycemia group,the measured sodium was lower,the difference between corrected sodium and measured sodium（Δ[Na]）was higher.There was no death in the hyperglycemia and non-hyperosmolar group（no statistical difference in prognosis）.4.Comparison between the higher-hyperglycemic hyperosmolar group and higher-hyperglycemia non-hypertonic groupCompared with the n HHS hyperglycemia group,Glu,age,BUN,and SCr were significantly different in the HHS hyperglycemia group（P<0.05）.Compared with the n HHS hyperglycemia group,in the HHS hyperglycemia group,the Na,corrected sodium,Δ[Na]were higher,and the difference was statistically significant（P<0.001）.There were 7 deaths in the HHS hyperglycemia group and no death in the n HHS hyperglycemia group.5.Comparison between the lower-hyperglycemic hyperosmolar group and lower-hyperglycemia non-hypertonic groupCompared with the n HHS hypoglycemia group,the HHS hypoglycemia group had statistical differences in age,BUN,and SCr（P<0.05）.Compared with the n HHS hypoglycemia group,Na,corrected sodium andΔ[Na]in the HHS hypoglycemia group were higher,and the difference was statistically significant（P<0.01）.There was 1 death in the HHS hypoglycemia group;and no death in the n HHS hypoglycemia group.Conclusion Compared with the measured sodium,the corrected sodium can more accurately reflect the osmotic pressure of the body under the condition of hyperglycemia.Corrected sodium can reflect the serum tonicity regulation ability of the body when blood glucose rises,which can use to predict the risk of HHS and the prognosis of patients.The difference between corrected sodium and measured sodium can also reflect the state of osmotic pressure regulation of the body.