Predictive Value Of Initial Serum Sodium Level Combined With CRP,NHPCT,Lactate,and APACHE Ⅱ Score For Prognosis In Patients With Sepsis-Induced Shock

Objective: This study aimed to explore independent risk factors associated with the prognosis of sepsis-induced shock and evaluate the predictive value of a multi-index combined model for prognosis.Additionally,the relationship between the initial serum sodium level and prognosis in sepsis-induced shock patients was investigated to assess the predictive value of serum sodium level for prognosis.Methods: This retrospective study included 136 patients with sepsis-induced shock admitted to the Intensive Care Unit of Qingdao Municipal Hospital between January 2020 and January 2022.General clinical data,including gender,age,vital signs,underlying diseases,site of infection,and complications,were collected.Mean arterial pressure(MAP)was calculated,and the APACHE II score and SOFA score were calculated according to standard criteria.The primary outcome variable was the 28-day prognosis.The initial serum sodium level was measured upon admission,and patients were categorized into three subgroups based on serum sodium levels: low sodium group(sodium < 135 mmol/L),normal sodium group(sodium 135-145 mmol/L),and high sodium group(sodium > 145 mmol/L).Group comparisons were performed using one-way ANOVA,Mann-Whitney U test,independent samples t-test,etc.Logistic regression models were used to determine independent risk factors and their odds ratios(ORs)for 28-day mortality in sepsis-induced shock patients.A combined model was constructed using regression model coefficients,and the predictive abilities of individual risk factors and the model were evaluated using the area under the curve(AUC)index.Survival curves were compared among different groups based on cutoff values for each risk factor.Results: The study included 136 patients with sepsis-induced shock,with 66 patients in the survival group(48.53%)and 70 patients in the death group(51.47%).Significant differences between the two groups were observed in baseline diseases(diabetes),complications(respiratory failure,renal failure,coagulation dysfunction,MODS),and infection sites(urinary tract infection,skin and superficial soft tissue infection)(P < 0.05).Significant differences were also observed between the two groups in initial serum sodium level,C-reactive protein(CRP),procalcitonin(PCT),alanine transaminase(ALT),aspartate transaminase(AST),brain natriuretic peptide(BNP),lactate,and APACHE II score(P < 0.05).The high sodium group showed significant differences compared to the normal sodium and low sodium groups in heart rate,CRP,blood urea nitrogen,PCT,lactate,and mean arterial pressure(P < 0.05).Multivariate logistic regression analysis revealed that high sodium and low sodium were independent risk factors for 28-day mortality in sepsis-induced shock patients(OR = 4.6;2.318;95% CI 1.135-11.746;1.134-18.652;P < 0.05).ROC curve analysis demonstrated that the independent risk factors CRP,PCT,lactate,and APACHE II score had AUC values of 0.895,0.719,0.910,and 0.701,respectively,for predicting prognosis in sepsis-induced shock patients(P < 0.05).Survival curve analysis based on cutoff values showed that patients with CRP > 169.24 mg/L,PCT > 11.24 ng/m L,lactate > 7.6 mmol/L,serum sodium > 147 mmol/L,and APACHE II score > 14 had lower cumulative survival probability at 28 days(P <0.05).The combined models,including serum sodium + lactate,serum sodium +APACHE II score,serum sodium + lactate + APACHE II score,serum sodium + CRP+ PCT,and all risk factors,showed AUC values of 0.939,0.837,0.962,0.948,and0.996,respectively(P < 0.05).Conclusion: 1.Initial serum sodium level,CRP,PCT,lactate,and APACHE II score are independent risk factors for 28-day mortality in sepsis-induced shock,with lactate showing the highest predictive ability among the examined markers.2.Sepsis-induced shock patients with CRP > 169.24 mg/L,PCT > 11.24 ng/m L,lactate > 7.6 mmol/L,serum sodium > 147 mmol/L,and APACHE II score > 14 have a lower cumulative survival probability at 28 days.3.The combination of initial serum sodium level,CRP,PCT,lactate,and APACHE II score provides the best predictive performance for prognosis in septic shock.