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

The aim was to evaluate the predictive value of serial serum sodium determination for mortality in enteric fistula (EF) patients complicated with sepsis.

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.

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.

Serum sodium was a reliable predictor for mortality in abdominal septic patients, which should be paid close attention in the critical care.