Increased ICU mortality in septic shock patients with hypo- or hyper- serum osmolarity: A retrospective study

Gang Heng; Jiasi Zhang; Yi Dong; Jiankun Jia; Benqi Huang; Yanbing Shen; Dan Wang; Zhen Lan; Jianxin Zhang; Tao Fu; Weidong Jin

doi:10.3389/fmed.2023.1083769

Increased ICU mortality in septic shock patients with hypo- or hyper- serum osmolarity: A retrospective study

Front Med (Lausanne). 2023 Feb 1:10:1083769. doi: 10.3389/fmed.2023.1083769. eCollection 2023.

Authors

Gang Heng¹, Jiasi Zhang², Yi Dong^{1

3}, Jiankun Jia¹, Benqi Huang⁴, Yanbing Shen¹, Dan Wang¹, Zhen Lan¹, Jianxin Zhang¹, Tao Fu¹, Weidong Jin^{1

3}

Affiliations

¹ Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China.
² Center of Haematology, Southwest Hospital, Army Medical University, Chongqing, China.
³ The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁴ Department of Quality Education, Jiangsu Vocational College of Electronics and Information, Huaian, China.

Abstract

Background: While many factors that are associated with increased mortality in septic shock patients have been identified, the effects of serum osmolarity on the outcomes of ICU patients with septic shock have not yet been studied.

Methods: The present study was designed to examine the association of serum osmolarity with ICU 28-day mortality in ICU patients with septic shock. Adult patients diagnosed with septic shock from the MIMIC-IV database were selected in this study. The serum osmolarity was calculated synchronously according to the serum concentrations of Na⁺, K⁺, glucose, and urea nitrogen.

Results: In the present study, a significant difference was observed between the 28-day mortality of septic shock patients with hypo-osmolarity, hyper-osmolarity, and normal osmolarity (30.8%, 34.9%, and 23.0%, respectively, p < 0.001), which were detected at ICU admission. After propensity score matching (PSM) for basic characteristics, the relatively higher mortality was still observed in the hypo-osmolarity and hyper-osmolarity groups, compared to normal osmolarity group (30.6%, 30.0% vs. 21.7%, p = 0.009). Furthermore, we found that transforming the hyper-osmolarity into normal osmolarity by fluid therapy on day 2 and 3 decreased this mortality.

Conclusion: The serum osmolarity disorder is markedly associated with increased 28-day mortality in septic shock patients.

Keywords: ICU mortality; hyper-osmolarity; hypo-osmolarity; septic shock; serum osmolarity.

Grants and funding

This work was supported by the China Postdoctoral Science Foundation under grant number 2018T111159 and Hubei Province Health and Family Planning Scientific research project (WJ2023F038).