The Predictive Value Of Serum Sodium Variability Within 72 Hours,Lactic Acid And Severity Score For The Prognosis Of Patients With Infection And Sepsis In Intensive Care Unit

Objective:The purpose of this study was to explore the effect of 72 h serum sodium variability and lactic acid and other serological indicators combined with severity score on the severity of infection in intensive care unit and the 28-day death of patients with sepsis.At the same time,a combined prediction model of 28-day mortality of patients with sepsis in ICU was established to evaluate its predictive value for the prognosis of sepsis.Methods:From December 2020 to December 2021,a total of 298 patients with infection or suspected infection were selected for this study.The selected patients were divided into sepsis group and non-sepsis group/sepsis death group and non-death group according to whether they developed into sepsis/sepsis patients and whether they died after 28 days.The72-hour blood sodium variability,lactic acid,severity score of illness and other clinical related data of the sepsis and non-suppsis groups were included in the univariate analysis,and those with statistical significance were included in the logistic regression analysis.Clinically relevant data such as 72-hour blood sodium variability,lactic acid,disease severity scores,and other clinical data for the infectious death and non death groups were included in a univariate analysis,while statistically significant data were included in a binary logistic regression analysis.At the same time,a joint prediction model was established,and the ROC curve was drawn to evaluate its predictive value for the 28-day death of the patients with sepsis.SPSS23 software was used for all statistical analysis.The significance level of each analysis was set as P<0.05.Results:In this study,298 patients were enrolled according to the inclusion criteria and exclusion criteria.There were 135 patients with sepsis(62 died in 28 days and 73 survived in 28 days)and 163 patients without sepsis.The diastolic blood pressure,Hb,PLT,Pa CO2 and Alb in the septic patients group were significantly lower than those in the non septic patients group,while the CRP,Lac,APTT,Scr,TBil,72 h blood sodium variability,SOFA score and APACHE Ⅱ in the septic patients group were significantly higher than those in the non septic patients group(P<0.05).The above statistically significant indicators were included in the logistic regression analysis.It was found that CRP,Lac,72 h blood sodium variability,APACHE Ⅱ and SOFA score were independent risk factors for the development of sepsis in patients with infection in the intensive care unit(P<0.05).Lac,72 h blood sodium variability,APACHE Ⅱ and SOFA score in septic death group were significantly higher than those in septic non-death group(P<0.05).The above statistically significant indicators were included in the logistic regression analysis,and it was found that Lac,72 h blood sodium variability,APACHE Ⅱ and SOFA score were independent risk factors for28-day death of patients with sepsis(P<0.05).The combined prediction model for 28-day mortality prediction of sepsis patients was established by logistic regression equation,and the ROC curve was drawn at the same time.It was found that the prediction efficiency of the combined prediction model(72h blood sodium variability+Lac+SOFA score+APACHE II(AUC: 0.917;95% CI: 0.870～0.965)was better than any single index.Conclusion:1.CRP,Lac,serum sodium variability within 72 hours,APACHE Ⅱ and SOFA score were independent risk factors for sepsis in patients with infection in ICU.2.Lac,serum sodium variability within 72 hours,APACHE Ⅱ and SOFA score were independent risk factors for 28 d death in patients with sepsis.3.The combined prediction model(serum sodium variability within 72 hours+Lac+SOFA score+APACHE Ⅱ score(AUC: 0.917;95% CI: 0.870～0.965)has a better prediction effect than any single index(serum sodium variability within 72 hours,Lac,SOFA score,APACHE Ⅱ score).