Klopotowski Mariusz, Kruk Mariusz, Przyluski Jakub, Kalinczuk Lukasz, Pregowski Jerzy, Bekta Pawel, Malek Lukasz A, Kepka Cezary, Ciszewski Andrzej, Chmielak Zbigniew, Demkow Marcin, Karcz Maciej, Witkowski Adam, Ruzyllo Witold
1st Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland.
Med Sci Monit. 2009 Sep;15(9):CR477-83.
Hyponatremia is a common electrolyte disorder reported to be a predictor of poor prognosis among hospitalized patients, but individuals with high levels also tend to have less favorable outcomes. This study investigated whether sodium level on admission is predictive of in-hospital outcome in patients with ST-elevation myocardial infarction (STEMI) treated with primary angioplasty.
MATERIAL/METHODS: Included were 1858 patients admitted with STEMI for primary angioplasty. Sodium level was measured on admission and analyzed as hypo- versus normonatremia and by grouping patients into sodium quintiles. The relationships between sodium level and in-hospital mortality as well as the composite of death or heart failure were assessed.
Ninety-six patients had hyponatremia on admission. The hypo- and normonatremic groups were comparable with respect to baseline characteristics and in-hospital management. Hyponatremics had higher rates of in-hospital mortality (13.5% vs. 3.8%, p<0.001) composite of death and heart failure (27.8% vs. 18.4%, p=0.022). After adjustment for covariates, hyponatremia independently correlated with in-hospital mortality (HR: 3.89, 95%CI: 1.59-9.56, p=0.003) and the combined endpoint (HR: 1.73, 95%CI: 1.01-2.99, p=0.047). Patients in the lowest and highest sodium quintiles were 3.27 (95%CI: 1.34-8.02, p=0.009) and 2.65 (95%CI: 1.07-6.60, p=0.036) times more likely to die during hospitalization than those in the 2nd quintile (best survival). In the adjusted model, only patients in the lowest quintile had significantly increased risk of in-hospital death (HR: 6.35, 95%CI: 1.83-21.72, p=0.004).
Hyponatremia is a simple laboratory marker independently associated with increased risk of death in STEMI patients treated with primary angioplasty.
低钠血症是一种常见的电解质紊乱，据报道是住院患者预后不良的预测指标，但钠水平高的个体往往预后也较差。本研究调查了入院时的钠水平是否可预测接受直接血管成形术治疗的ST段抬高型心肌梗死（STEMI）患者的院内结局。
材料/方法：纳入1858例因STEMI入院接受直接血管成形术的患者。入院时测量钠水平，并分析低钠血症与正常钠血症情况，以及将患者分为钠水平五分位数组。评估钠水平与院内死亡率以及死亡或心力衰竭复合结局之间的关系。
96例患者入院时存在低钠血症。低钠血症组和正常钠血症组在基线特征和院内治疗方面具有可比性。低钠血症患者的院内死亡率（13.5%对3.8%，p<0.001）以及死亡和心力衰竭复合结局发生率（27.8%对18.4%，p=0.022）更高。在对协变量进行调整后，低钠血症与院内死亡率（HR：3.89，95%CI：1.59 - 9.56，p=0.003）以及联合终点（HR：1.73，95%CI：1.01 - 2.99，p=0.047）独立相关。钠水平最低和最高五分位数组的患者在住院期间死亡的可能性分别是第二五分位数组（生存最佳）患者的3.27倍（95%CI：1.34 - 8.02，p=0.009）和2.65倍（95%CI：1.07 - 6.60，p=0.036）。在调整模型中，只有最低五分位数组的患者院内死亡风险显著增加（HR：6.35，95%CI：1.83 - 21.72，p=0.004）。
低钠血症是一个简单的实验室指标，与接受直接血管成形术治疗的STEMI患者死亡风险增加独立相关。
