[Analysis of influencing factors for the occurrence of transient hypernatremia in patients with extremely severe burns].
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Objective: To investigate the influencing factors for the occurrence of transient hypernatremia (TH) in patients with extremely severe burns. Methods: This study was a bidirectional cohort study. Clinical data of 126 patients with extremely severe burns (97 males and 29 females, aged 18 to 64 years) who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Medical University from August 2021 to December 2025 were retrospectively analyzed. The incidence of hypernatremia was recorded. Among 118 patients who underwent surgical treatment, patients who underwent first escharectomy at ≤5 days after injury were included in early escharectomy group (n=39), and patients who underwent first escharectomy at >5 days after injury were included in late escharectomy group (n=79). The incidence of hypernatremia was compared between the two groups of patients. According to whether they received air-fluidized bed (AFB) therapy, patients were divided into AFB group (n=89) and non-AFB group (n=37). The incidence of hypernatremia was compared between the two groups of patients, and independent risk factors for the occurrence of hypernatremia in patients with extremely severe burns were screened. For patients who underwent pulse contour cardiac output (PiCCO) monitoring during the shock stage, extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were compared between the 20 patients with hypernatremia and the 35 patients without hypernatremia. Fifty-five patients with extremely severe burns (35 males and 20 females, aged 20 to 63 years) who met the inclusion criteria and were admitted to this hospital from May to December 2025 were prospectively enrolled. At 3 days after injury, eschar tissue, wound skin tissue, and peripheral venous blood were collected. Using the random number table method, specimens from 5 patients with hypernatremia (set as high Na+ group) and 5 patients without hypernatremia (set as non-high Na+ group) were selected. Sodium content in eschar was determined by inductively coupled plasma mass spectrometry. Serum levels of interleukin-1 (IL-1), IL-6, tumor necrosis factor-α (TNF-α), and hyaluronic acid were detected by enzyme-linked immunosorbent assay. Protein expression level of sodium voltage-gated channel alpha subunit 5 (SCN5A) in wound skin tissue was detected by Western blotting. Results: In the retrospective cohort study of 126 patients, 50 patients (39.7%) developed hypernatremia 3 to 5 days after injury, among whom 41 had TH, and 9 died. In the 41 patients with TH, the serum sodium began to increase 2 to 3 days after injury, peaked at 5 to 8 days after injury, and gradually recovered by 10 days after injury. The incidence of hypernatremia of patients in late escharectomy group was 32.9% (26/79), which was significantly higher than 7.7% (3/39) in early escharectomy group (χ2=8.96, P<0.05). The incidence of hypernatremia of patients in AFB group was significantly higher than that in non-AFB group (P<0.05). The results of multivariate logistic regression analysis showed that AFB therapy was not an independent risk factor for hypernatremia in patients with extremely severe burns (OR=1.80, with a 95% CI of 0.40 to 8.20, P>0.05), while both total burn area and full-thickness burn area were independent risk factors for hypernatremia in patients with extremely severe burns (with ORs of 3.50 and 2.10, respectively, 95% CIs of 1.90 to 6.70 and 1.20 to 3.80, respectively, P<0.05). Among patients who underwent PiCCO monitoring during the shock stage, EVLWI and PVPI in patients with hypernatremia were significantly higher than those in patients without hypernatremia (with t values of 3.45 and 4.28, respectively, P<0.05). In the prospective cohort study, sodium content in eschar at 3 days after injury in high Na+ group of patients was (128±9) mmol/kg, which was significantly higher than (102±6) mmol/kg in non-high Na+ group (t=5.38, P<0.05). Compared with those in non-high Na+ group, serum levels of IL-1, IL-6, TNF-α, and hyaluronic acid in high Na+ group of patients were significantly increased 3 days after injury (P<0.05), while the protein expression level of SCN5A in wound skin tissue was significantly decreased (P<0.05). Conclusions: TH after extremely severe burns is not merely an elevation in serum sodium, but involves sodium accumulation in eschar, inflammation-mediated sodium redistribution, and sodium release during the reabsorption phase. Early escharectomy can effectively reduce the risk of occurrence of TH in patients with extremely severe burns, and its mechanism may be associated with the removal of some sodium-containing eschar and a reduction in sodium release.