Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Medicine, Cardiology Section, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America.
Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America.
Int J Cardiol. 2019 Sep 1;290:119-124. doi: 10.1016/j.ijcard.2019.03.040. Epub 2019 Mar 22.
The purpose of our study is to examine whether serial measurements of serum sodium values after diagnosis identify a higher-risk subset of patients with heart failure with preserved ejection fraction.
We identified 50,932 subjects with HFpEF with 759,577 recorded sNa measurements (mean age 72 ± 11 years) using a validated algorithm in the VA national database from 2002 to 2012. We examined the association of repeated measures of sNa with mortality using a multivariable Cox proportional hazards model.
After a median follow-up of 2.9 years (IQR: 1.2-5.4), 19,011 deaths occurred. After adjusting for age, sex, race, BMI, glomerular filtration rate, potassium, coronary artery disease, hypertension, hyperlipidemia, atrial fibrillation, pulmonary disease, diabetes, anemia, and medications, we found J-shaped associations of serum sodium with mortality. HRs for all-cause mortality were 2.48 (95% CI: 2.38-2.60) for the sNA 115.00-133.99 category; and 1.40 (95% CI: 1.35-1.46) for the sNA 143.00-175.00 category compared to the 137.01-140.99 category (ref). We used generalized estimating equation-based negative binomial regression to compute the incidence density ratios (IDR) to examine days hospitalized for heart failure and for all causes. There were a total of 1,275,614 days of all-cause hospitalization and 104,006 days of heart-failure hospitalization. The IDRs for the lowest sNA group were 2.03 (95% CI: 1.90-2.18) for all-cause hospitalization and 1.73 (95% CI: 1.39-2.16) for heart-failure hospitalization.
Our findings suggest that monitoring of serum sodium values during longitudinal follow-up can identify HFpEF patients at risk of adverse outcomes.
本研究旨在探讨心力衰竭射血分数保留患者（HFpEF）诊断后血清钠值的连续测量是否能确定更高风险的亚组患者。
我们使用 VA 国家数据库中经过验证的算法，从 2002 年至 2012 年，确定了 50932 例 HFpEF 患者，共记录了 759577 次 sNa 测量值（平均年龄 72±11 岁）。我们使用多变量 Cox 比例风险模型检查了 sNa 重复测量与死亡率之间的关联。
中位随访 2.9 年后（IQR：1.2-5.4），发生 19011 例死亡。在校正年龄、性别、种族、BMI、肾小球滤过率、钾、冠状动脉疾病、高血压、高血脂、房颤、肺部疾病、糖尿病、贫血和药物后，我们发现血清钠与死亡率呈 J 形相关。全因死亡率的 HR 为 sNa 115.00-133.99 类别为 2.48（95%CI：2.38-2.60）；sNa 143.00-175.00 类别为 1.40（95%CI：1.35-1.46），与 sNa 137.01-140.99 类别相比（参考）。我们使用基于广义估计方程的负二项式回归计算发病率密度比（IDR），以检查因心力衰竭和所有原因住院的天数。共有 1275614 天因所有原因住院和 104006 天因心力衰竭住院。最低 sNa 组的 IDR 为因所有原因住院的 2.03（95%CI：1.90-2.18）和因心力衰竭住院的 1.73（95%CI：1.39-2.16）。
我们的研究结果表明，在纵向随访期间监测血清钠值可以识别 HFpEF 患者的不良结局风险。
