A retrospective cross-sectional study utilizing data from the MIMIC-IV database explored the relationship between serum sodium (SNa) levels and the risk of Sepsis-Related Liver Injury (SRLI) in 11,809 adult ICU patients with sepsis (mean age 65.8±17.1 years).

The study found a high prevalence of SRLI at 42.5%. Multivariable logistic regression revealed that SNa was inversely associated with SRLI (aOR 0.99; 95% CI 0.98–0.99; P<0.05). Further analysis using Generalized Additive Models (GAM) indicated a nonlinear, inverse association with a saturation effect, specifically identifying a threshold at 135 mmol/L. Below this threshold (SNa≤135 mmol/L), lower sodium levels were significantly associated with an increased risk of SRLI. Conversely, above the 135 mmol/L threshold, the association was not statistically significant. This inverse relationship was particularly strong in the subgroup of patients with cirrhosis. The findings suggest that incorporating SNa levels, especially hyponatremia, into the clinical assessment of sepsis patients may be valuable for risk stratification, though multicenter prospective studies are needed to confirm its clinical utility.

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