Abstract:

Serum sodium as a prognostic biomarker in enteric fistula patients complicated with sepsis        WU Yin，REN Jian-an，LI Guan-wei，et al. Research Institute of General Surgery，Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing 210002，China
Corresponding author：REN Jian-an，E-mail：JiananR@gmail.com
Abstract    Objective To evaluate the predictive value of serum sodium determination for mortality in enteric fistula patients complicated with sepsis. Methods    A total of 162 enteric fistula patients complicated with sepsis admitted between January 2012 and January 2013 in Department of General Surgery, Nanjing General Hospital of Nanjing Military Command of PLA were analyzed. Patients were divided into survivors group（119 patients）and nonsurvivors group（43 patients） according to their 28-day outcomes. Laboratory variables（[Na+] and PCT）on day 3 and day 7 after admission were observed. All the variables were analyzed by ROC curve. A total of 116 patients admitted between January 2013 and October 2013 were classified as the control group and determination value of all the variables were analyzed. Results    ROC analysis showed that [Na+]7>147.5 mmol/L and Δ[Na+]7>5.2 mmol/L were reliable predictors ([Na+]7: 81.2% sensitivity，87.7% specificity，AUC=0.872，P <0.001. Δ[Na+]7: 81.3% sensitivity，83.6% specificity，AUC=0.836，P<0.001) for mortality. The combination form （[Na+]7>147.5 mmol/L+Δ[Na+]7>5.2 mmol/L + ΔPCT7<5.3 ng/mL, AUC=0.899，P<0.001）had highest predictive value. Conclusion    Serum sodium is a reliable predictor for 28-day mortality in enteric fistula patients complicated with sepsis. Hypernatremia and excessive volatility of serum sodium are the sensitive warning indicators. Surgeons should pay attention to the parameters in the critical care.

Key words: enteric fistula, sepsis, hypernatremia, prognosis, biomarker

摘要：

目的    评价血清钠浓度对肠瘘合并腹腔感染病人死亡情况的预测价值。方法    选择2012年1月至2013年1月南京军区南京总医院普通外科收治的162例肠瘘合并腹腔感染病人作为推导队列，根据28 d死亡情况将病人分为生存组（119例）和死亡组（43例）。监测病人入院当天及入院第3、7天的各项生化指标［血清钠浓度（［Na+］）、血清降钙素原（PCT）］。以［Na+］为例：［Na+］0、［Na+］3、［Na+］7分别为入院当天和入院后第3、7天的［Na+］；Δ［Na+］3 = ［Na+］3-［Na+］0；Δ［Na+］7= ［Na+］7-［Na+］0；Δ［Na+］7-3= ［Na+］7-［Na+］3。其余指标以此类推。使用ROC曲线分析各指标对预后的影响。同时，选择2013年1-10月的116例相关病人作为验证队列，对各指标的预测价值进行验证。结果    ROC曲线分析表明，［Na+］7>147.5 mmol/L和Δ［Na+］7>5.2 mmol/L可准确地预测病人的死亡情况。［Na+］7：敏感度81.2%，特异度87.7%，AUC=0.872（P<0.001）；Δ［Na+］7：敏感度81.3%，特异度83.6%，AUC=0.836（P<0.001）。联合多个指标预测的准确度最高：［Na+］7>147.5 mmol/L+Δ［Na+］7>5.2 mmol/L+ΔPCT7<5.3 ng/mL（AUC=0.899，P<0.001）。结论    动态监测血清钠浓度可预测肠瘘合并腹腔感染病人的28 d死亡情况，高钠血症和血钠波动幅度过大是敏感的预警指标，应该在危重症病人的临床监护中加以重视。

关键词: 肠瘘, 脓毒症, 高钠血症, 预后, 生物标记物