Abstract：
BACKGROUND: Sepsis is a recognized global health challenge that places a considerable disease burden on countries. Although there has been some progress in the study of sepsis, the mortality rate of sepsis remains high. The relationship between serum osmolality and the prognosis of patients with sepsis is unclear.
METHODS: Patients with sepsis who met the criteria in the Medical Information Mart for Intensive Care IV database were included in the study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined using multivariable Cox regression. The relationship between serum osmolality and the 28-day mortality risk in patients with sepsis was investigated using curve fitting, and inflection points were calculated.
RESULTS: A total of 13,219 patients with sepsis were enrolled in the study; the mean age was 65.1 years, 56.9 % were male, and the 28-day mortality rate was 18.8 %. After adjusting for covariates, the risk of 28-day mortality was elevated by 99% (HR 1.99, 95%CI 1.74-2.28) in the highest quintile of serum osmolality (Q5 >303.21) and by 59% (HR 1.59, 95%CI 1.39-1.83) in the lowest quintile (Q1 ≤285.80), as compared to the reference quintile (Q3 291.38-296.29). The results of the curve fitting showed a U-shaped relationship between serum osmolality and the risk of 28-day mortality, with an inflection point of 286.9 mmol/L.
CONCLUSIONS: There is a U-shaped relationship between serum osmolality and the 28-day mortality risk in patients with sepsis. Higher or lower serum osmolality is associated with an increased risk of mortality in patients with sepsis. Patients with sepsis have a lower risk of mortality when their osmolality is 285.80-296.29 mmol/L.
METHODS: Patients with sepsis who met the criteria in the Medical Information Mart for Intensive Care IV database were included in the study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined using multivariable Cox regression. The relationship between serum osmolality and the 28-day mortality risk in patients with sepsis was investigated using curve fitting, and inflection points were calculated.
RESULTS: A total of 13,219 patients with sepsis were enrolled in the study; the mean age was 65.1 years, 56.9 % were male, and the 28-day mortality rate was 18.8 %. After adjusting for covariates, the risk of 28-day mortality was elevated by 99% (HR 1.99, 95%CI 1.74-2.28) in the highest quintile of serum osmolality (Q5 >303.21) and by 59% (HR 1.59, 95%CI 1.39-1.83) in the lowest quintile (Q1 ≤285.80), as compared to the reference quintile (Q3 291.38-296.29). The results of the curve fitting showed a U-shaped relationship between serum osmolality and the risk of 28-day mortality, with an inflection point of 286.9 mmol/L.
CONCLUSIONS: There is a U-shaped relationship between serum osmolality and the 28-day mortality risk in patients with sepsis. Higher or lower serum osmolality is associated with an increased risk of mortality in patients with sepsis. Patients with sepsis have a lower risk of mortality when their osmolality is 285.80-296.29 mmol/L.
摘要：
背景：脓毒症是公认的全球健康挑战，给各国带来了相当大的疾病负担。尽管脓毒症的研究已经取得了一定的进展,脓毒症的死亡率仍然很高。血清渗透压与脓毒症患者预后的关系尚不清楚。
方法：符合重症监护医学信息集市数据库中标准的脓毒症患者被纳入研究。使用多变量Cox回归确定危险比（HR）和95％置信区间（CI）。使用曲线拟合研究脓毒症患者血清渗透压与28天死亡风险之间的关系。并计算了拐点。
结果：共有13,219例脓毒症患者纳入研究；平均年龄为65.1岁，56.9%为男性，28天死亡率为18.8%。在调整协变量后，在血清渗透压最高的五分之一（Q5>303.21）中，28天死亡率的风险升高了99％（HR1.99，95CI1.74-2.28），在最低的五分之一（Q1≤285.80）中升高了59％（HR1.59，95CI1.39-1.83），与参考五分位数(Q3291.38-296.29)相比。曲线拟合结果显示血清渗透压与28天死亡风险呈U型关系,拐点为286.9mmol/L
结论：脓毒症患者血清渗透压与28天死亡风险呈U型关系。较高或较低的血清渗透压与脓毒症患者死亡风险增加相关。当渗透压为285.80-296.29mmol/L时，脓毒症患者的死亡风险较低。
方法：符合重症监护医学信息集市数据库中标准的脓毒症患者被纳入研究。使用多变量Cox回归确定危险比（HR）和95％置信区间（CI）。使用曲线拟合研究脓毒症患者血清渗透压与28天死亡风险之间的关系。并计算了拐点。
结果：共有13,219例脓毒症患者纳入研究；平均年龄为65.1岁，56.9%为男性，28天死亡率为18.8%。在调整协变量后，在血清渗透压最高的五分之一（Q5>303.21）中，28天死亡率的风险升高了99％（HR1.99，95CI1.74-2.28），在最低的五分之一（Q1≤285.80）中升高了59％（HR1.59，95CI1.39-1.83），与参考五分位数(Q3291.38-296.29)相比。曲线拟合结果显示血清渗透压与28天死亡风险呈U型关系,拐点为286.9mmol/L
结论：脓毒症患者血清渗透压与28天死亡风险呈U型关系。较高或较低的血清渗透压与脓毒症患者死亡风险增加相关。当渗透压为285.80-296.29mmol/L时，脓毒症患者的死亡风险较低。
