Variability in serum sodium concentration and its prognostic significance in severe burn injuries: A retrospective study

Dysnatremia is a common electrolyte disturbance in severe burn patients and may significantly impact prognosis. This study investigated the association between serum sodium variability and mortality in adults with extensive burn injuries. In this retrospective cross-sectional study, ۳۰۰ adult burn patients with burns involving more than ۲۰% of total body surface area (TBSA) and at least second-degree depth were included. Patients were admitted to Velayat Burn and Plastic Surgery Center (Rasht, Iran) between March ۲۰۱۸ and March ۲۰۲۰. Serum sodium was measured daily during hospitalization. Hypernatremia and hyponatremia were defined as serum sodium >۱۴۵ mmol/L and <۱۳۵ mmol/L, respectively. Sodium variability was quantified as the standard deviation (SD) of daily sodium measurements. Multivariate logistic regression was used to identify independent predictors of in-hospital mortality. Of the ۳۰۰ patients (mean age: ۴۷.۵ ± ۱۳.۵ years; mean TBSA: ۳۹.۸ ± ۲۱.۹%), ۲۱.۳% of the patients had hypernatremia, and ۳۳ (۱۱%) developed hyponatremia. Overall mortality was ۳۶.۷%. Non-survivors had significantly higher mean serum sodium levels (۱۴۳.۲ ± ۸.۹ vs. ۱۳۸.۶ ± ۳.۰ mmol/L; P < ۰.۰۰۰۱) and greater sodium variability. Multivariate analysis identified age (Odds ratio (OR): ۱.۱۵; P = ۰.۰۰۴), TBSA (OR: ۱.۲۴; P = ۰.۰۰۲), mechanical ventilation duration (OR: ۱.۳۸; P < ۰.۰۰۱), inhalation injury (OR: ۲۳.۵; P = ۰.۰۰۳), and sodium variability (OR: ۱.۱۲; P = ۰.۰۰۴) as independent predictors of mortality. Dysnatremia—particularly hypernatremia—and greater serum sodium variability are strongly associated with increased mortality in patients with severe burns. These findings underscore the prognostic importance of sodium monitoring and suggest that minimizing sodium fluctuations may improve outcomes in critically ill burn patients. Further prospective studies are warranted to validate these associations and inform clinical management strategies.Dysnatremia is a common electrolyte disturbance in severe burn patients and may significantly impact prognosis. This study investigated the association between serum sodium variability and mortality in adults with extensive burn injuries. In this retrospective cross-sectional study, ۳۰۰ adult burn patients with burns involving more than ۲۰% of total body surface area (TBSA) and at least second-degree depth were included. Patients were admitted to Velayat Burn and Plastic Surgery Center (Rasht, Iran) between March ۲۰۱۸ and March ۲۰۲۰. Serum sodium was measured daily during hospitalization. Hypernatremia and hyponatremia were defined as serum sodium >۱۴۵ mmol/L and <۱۳۵ mmol/L, respectively. Sodium variability was quantified as the standard deviation (SD) of daily sodium measurements. Multivariate logistic regression was used to identify independent predictors of in-hospital mortality. Of the ۳۰۰ patients (mean age: ۴۷.۵ ± ۱۳.۵ years; mean TBSA: ۳۹.۸ ± ۲۱.۹%), ۲۱.۳% of the patients had hypernatremia, and ۳۳ (۱۱%) developed hyponatremia. Overall mortality was ۳۶.۷%. Non-survivors had significantly higher mean serum sodium levels (۱۴۳.۲ ± ۸.۹ vs. ۱۳۸.۶ ± ۳.۰ mmol/L; P < ۰.۰۰۰۱) and greater sodium variability. Multivariate analysis identified age (Odds ratio (OR): ۱.۱۵; P = ۰.۰۰۴), TBSA (OR: ۱.۲۴; P = ۰.۰۰۲), mechanical ventilation duration (OR: ۱.۳۸; P < ۰.۰۰۱), inhalation injury (OR: ۲۳.۵; P = ۰.۰۰۳), and sodium variability (OR: ۱.۱۲; P = ۰.۰۰۴) as independent predictors of mortality. Dysnatremia—particularly hypernatremia—and greater serum sodium variability are strongly associated with increased mortality in patients with severe burns. These findings underscore the prognostic importance of sodium monitoring and suggest that minimizing sodium fluctuations may improve outcomes in critically ill burn patients. Further prospective studies are warranted to validate these associations and inform clinical management strategies.

کلیدواژه ها:

Burns ، Hypernatremia ، Hyponatremia ، Prognosis ، Water-electrolyte imbalance