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.
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。