急性心力衰竭住院患者首次随访时钠浓度升高与更好的结局相关。

Rise of first follow-up sodium in patients hospitalized with acute heart failure is associated with better outcomes.

机构信息

Internal Medicine Department, OSF Saint Elizabeth Medical Center, Ottawa, IL, United States of America.

Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, United States of America.

出版信息

Int J Cardiol. 2018 Oct 15;269:201-206. doi: 10.1016/j.ijcard.2018.06.071. Epub 2018 Jun 19.

DOI:10.1016/j.ijcard.2018.06.071

PMID:30224032

Abstract

INTRODUCTION

The prognostic effect of the direction of change in sodium (Na) level from admission to subsequent check in patients with acute heart failure (HF) has not been previously explored.

METHODS

The ESCAPE trial data was utilized to study whether the rise of 1 follow-up Na (at day 3) relative to admission (among patients with admission hyponatremia) is associated with favorable outcomes. The study endpoints were all-cause rehospitalization and a composite of death, rehospitalization and cardiac transplant, both up to 6-month after discharge.

RESULTS

Patients with rise of 1 follow-up Na (n = 43) had an average admission Na of 130.1 meq/L which increased to 134 meq/L at day 3 (P < 0.001), while patients without rise of 1 follow up Na (n = 46) had an admission Na of 131 meq/L which decreased to 128.9 meq/L at day 3 (P < 0.001). There was an inverse association between the magnitude of change in Na level from admission to day 3 and the magnitude of change in blood urea nitrogen (BUN, r = -0.304, P = 0.004), creatinine (r = -0.401, P < 0.001) and weight (r = -0.279, P = 0.011) during the same time frame. Among those 89 cases, 56 (63%) were rehospitalized and 70 (79%) experienced the composite endpoint. Patients without rise in 1 follow-up Na had higher frequency of rehospitalization (76.1% vs. 48.8%, univariate Odds ratio (OR) 1.778, 95% CI 1.174-2.693, P = 0.009) and composite endpoint (89.1% vs. 67.4%, univariate OR 1.779, 95% CI 1.208-2.619, P = 0.017), compared with those with Na rise. Cox regression analysis showed that rise in 1 follow-up Na was independently associated with reduced rehospitalization (Hazard ratio (HR) 0.429, 95% CI 0.191-0.960, P = 0.04) and the composite endpoint (HR 0.430, 95% CI 0.201-0.920, P = 0.03) after covariate adjustment.

CONCLUSION

Rise of first follow-up Na in patients with HF decompensation and hyponatremia on admission is associated with favorable intermediate-term outcomes.

摘要

简介

心力衰竭（HF）患者入院时钠（Na）水平变化方向对预后的影响尚未被探索。

方法

利用 ESCAPE 试验数据，研究入院时低钠血症患者（n=43）的第 1 次随访 Na（第 3 天）升高是否与良好的结局相关。研究终点是全因再入院和死亡、再入院和心脏移植的复合终点，均在出院后 6 个月内。

结果

入院时 Na 升高的患者（n=43）平均入院 Na 为 130.1 meq/L，第 3 天增加至 134 meq/L（P<0.001），而入院时 Na 未升高的患者（n=46）的入院 Na 为 131 meq/L，第 3 天下降至 128.9 meq/L（P<0.001）。入院至第 3 天的 Na 水平变化幅度与血尿素氮（BUN，r=-0.304，P=0.004）、肌酐（r=-0.401，P<0.001）和体重（r=-0.279，P=0.011）的变化幅度呈负相关。在这 89 例患者中，56 例（63%）再入院，70 例（79%）发生复合终点。入院时第 1 次随访中 Na 无升高的患者再入院率更高（76.1% vs. 48.8%，单变量优势比（OR）1.778，95%置信区间（CI）1.174-2.693，P=0.009）和复合终点（89.1% vs. 67.4%，单变量 OR 1.779，95% CI 1.208-2.619，P=0.017），与 Na 升高的患者相比。Cox 回归分析显示，第 1 次随访中 Na 升高与再入院减少（风险比（HR）0.429，95%CI 0.191-0.960，P=0.04）和复合终点（HR 0.430，95%CI 0.201-0.920，P=0.03）相关，调整了协变量。