血清钠离子浓度联合红细胞比容对急性心力衰竭短期预后的预测价值

Predictive value of serum sodium combined with hematocrit for short-term prognosis of acute heart failure

目的:探讨低钠血症联合红细胞比容与急性心力衰竭(心衰)患者短期预后的关系。方法:选择2019年1月至2020年7月锦州医科大学阜新市中心医院收治的因急性心衰入院患者498例,记录患者临床情况、基础疾病、心脏彩色多普勒超声(彩超)指标以及入院24 h内化验指标。按照血清钠离子浓度将急性心衰患者分为血钠正常组(血清钠浓度≥135 mmol/L)和低钠血症组(血清钠浓度<135 mmol/L)。按照红细胞比容将低钠血症组分为稀释性低钠血症亚组(红细胞比容:男性<40%,女性<37%)和消耗性低钠血症亚组(红细胞比容:男性≥40%,女性≥37%)。比较各组患者住院期间死亡率,以及出院后30 d、90 d内死亡及再入院情况,分析血清钠离子浓度联合红细胞比容对患者出院短期预后的预测价值。结果:498例患者中,低钠血症患者86例,稀释性低钠血症34例,消耗性低钠血症52例。观察期间出现不良事件167例,稀释性低钠血症23例,消耗性低钠血症22例,血钠正常122例。调整基线特征后,稀释性低钠血症是急性心衰患者出院30 d和90 d不良事件的独立危险因素(P<0.05)。血清钠离子浓度、HCT及两者联合预测急性心衰患者短期预后的AUC分别为0.734、0.657、0.762(P<0.001)。结论:稀释性低钠血症是急性心衰患者短期预后的独立预测因子,预测价值较高。

Objective:To explore the relationship between hyponatremia combined with hematocrit and the short-term prognosis of patients with acute heart failure.Methods:498 patients with acute heart failure admitted to Fuxin Central Hospital of Jinzhou Medical University from January 2019 to July 2020 were selected.The clinical conditions,basic diseases,echocardiographic results,and laboratory indicators within 24 hours of admission were recorded.According to serum sodium,patients with acute heart failure were divided into normonatremic group(serum sodium≥135 mmol/L)and hyponatremic group(serum sodium<135 mmol/L).The patients with hyponatremia were divided into the dilutional hyponatremic group(hematocrit<40%for male or<37%for female)and depletional hyponatremic group(hematocrit≥40%for male or hematocrit≥37%for female)based on hematocrit levels.The mortality rate during hospitalization,death,and readmission within 30 and 90 days after discharge were compared in each group.The predictive value of Serum sodium combined with hematocrit on the short-term prognosis of patients after discharge was analyzed.Results:498 patients with acute heart failure were included,86 patients of the included patients had hyponatremia,included 34 patients with dilutional hyponatremia and 52 patients with depletional hyponatremia.Adverse events at the period of observation occurred in 167 patients,including 23 patients in the dilutional hyponatremia group,22 patients in the depletional hyponatremia group,and 122 patients in the normonatremic group.After adjustment for baseline characteristics,dilutional hyponatremia was independent risk factor with the incidence of adverse events for acute heart failure within 30 days and 90 days after discharge(P<0.05).The area under the curve(AUC)of serum sodium,HCT,and their combination in predicting short-term prognosis of patients with acute heart failure were 0.734,0.657,and 0.762(P<0.001).Conclusions:Dilutional hyponatremia is an independent predictor of short-term prognosis in patients with acute heart failure,with high predictive value.