入院时低钠血症对老年射血分数保留型心力衰竭患者预后评估的价值

Prognostic value of hyponatraemia on cardovascular mortality in elderly heart failure patients with preserved ejection fraction

目的探讨入院时低钠血症对射血分数保留型心力衰竭(HFpEF)患者预后评估价值。方法入选2017年1月至2019年6月在南京医科大学附属淮安第一医院心内科住院的老年HFpEF患者,根据入院时的血钠水平分为正常血钠组(血钠135~145 mmol/L)、轻度低钠组(血钠125~135 mmol/L)和中度低钠组(血钠115~125 mmol/L)。比较三组患者临床特征的差异,通过多因素Cox回归模型,分析入院时低钠血症对老年HFpEF患者预后评估的价值。结果共纳入380例患者,男性227例(59.7%),平均年龄(71.0±5.2)岁,入院血钠水平为(138.4±3.2)mmol/L,随访期间26例死亡(6.8%)。正常血钠组、轻度低钠血症组及中度低钠组的病死率分别为5.6%(18/324)、12.2%(5/41)和20.0%(3/15),差异有统计学意义(χ^(2)=6.759,P=0.034)。多因素Cox回归分析显示,校正入院时NYHA心功能分级、收缩压、心率、血红蛋白、血钾、e GFR及NT-proBNP水平后,血钠水平仍是老年HFpEF患者心源性死亡的独立预测因素(P=0.019)。与正常血钠组比较,低钠血症组老年HFpEF患者心源性死亡风险增加近1倍,差异有统计学意义(HR=1.820,95%CI 1.065~3.584,P=0.023)。Kaplan-Meier生存曲线比较,低钠血症组心源性死亡风险高于正常血钠组(χ^(2)=6.981,P=0.009)。结论入院时低钠血症是住院老年HFpEF患者心源性死亡的独立预测因素。

Objective To investigate the prognostic value of hyponatremia on cardiovascular mortality(CM)in elderly heart failure patients with preserved ejection fraction(HFpEF).Methods Elderly patients with HFpEF admitted to the Department of Cardiology in our hospital from January 2017 to June 2019 were divided into normal sodium level group(135 mmol/L≤Na^(+)≤145 mmol/L),mild hyponatremia group(125 mmol/L≤Na^(+)<135 mmol/L)and moderate hyponatremia group(125 mmol/L≤Na^(+)<135 mmol/L)according to serum sodium level at the first admission.Their clinical characteristics and laboratory test data were compared.The multivariate Cox regression model was used to analyze the prognostic value of hyponatremia on admission to elderly patients with HFpEF.Results A total of 380 patients with HFpEF were included,with a mean age of 71.0 years,227 males(59.7%);the serum sodium level on admission was(138.4±3.2)mmol/L.Twenty-six patients(6.8%)died during the follow up.The CM of elderly HFpEF patients with normal sodium level,mild hyponatremia and moderate hyponatremia were 5.6%(18/324),12.2%(5/41)and 20.0%(3/15),respectively.The differences were statistical significance(χ^(2)=6.759,P=0.034).Multivariate Cox regression analysis showed that the serum sodium level on admission remained as the independent predictor of cardiac death in patients with HFpEF(P=0.019)after adjusting NYHA classification,systolic blood pressure,heart rate,hemoglobin,serum potassium,e GFR and NT proBNP.Patients with hyponatremia had nearly 1 times higher risk of CM than those with normal sodium level(HR=1.820,95%CI 1.065~3.584,P=0.023).Furthermore,Kaplan Meier analysis showed that the patients with hyponatremia on admission had significant higher CM compare to those with normal sodium level(χ^(2)=6.981,P=0.009).Conclusion The hyponatremia on admission is an independent predictor of cardiovascular mortality in HFpEF patients.