Alem Manal M
Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Int J Gen Med. 2020 Jul 20;13:407-417. doi: 10.2147/IJGM.S260256. eCollection 2020.
Chronic heart failure (CHF) is a global health burden. Despite advances in treatment, there remain well-recognised morbidity and mortality. Risk stratification requires the identification and validation of biomarkers, old and new. Hyponatremia has re-emerged as a prognostic marker in CHF patients.
This is a retrospective cohort study on 241 CHF patients recruited from King Fahd Hospital of the University, Al-Khobar, Saudi Arabia (January 2005-December 2016). Their serum sodium and biochemical parameters were measured at baseline, along with 2-D echocardiographic assessments of left ventricular mass and ejection fraction. The primary endpoint was the association between hyponatremia and all-cause mortality (ACM) after a follow-up period of 24 months.
Mean age of patients was 60.61 ± 12.63 (SD) years; 65.1% were males, and type 2 diabetes mellitus (DM) was present in 71%. Baseline serum sodium was 138.00 (136, 140) (median and interquartile range). Hyponatremia (<135 meq/L) was present in 14.1%. After follow-up, 46 deaths had occurred. Multivariate Cox-proportional hazard model showed that type 2 DM, New York Heart Association (NYHA) class (III-IV vs I-II), age, and left ventricular mass index (LVMI) were significant and independent predictors of ACM, with HR 3.03 (95% CI; 1.13, 8.16) (P=0.028), HR 2.31 (95% CI; 1.11, 4.82) (P=0.026), HR 1.06 (95% CI; 1.03, 1.09) (P<0.001), and HR 1.01 (95% CI; 1.00, 1.02) (P=0.039), respectively. Estimated glomerular filtration rate (eGFR) was not a significant predictor. Kaplan-Meier survival analysis was used for the analysis of NYHA class and hyponatremia interactions and showed that hyponatremia had an association with poorer survival in patients with NYHA class III-IV rather than I-II (Log-rank test, P= 0.0009).
Hyponatremia was a feature in CHF patients, and ACM was predicted by type 2 DM, NYHA class, age, and LVMI. Hyponatremia impact on survival was in patients with more advanced disease.
慢性心力衰竭（CHF）是一项全球性的健康负担。尽管治疗方面取得了进展，但仍存在公认的发病率和死亡率。风险分层需要识别和验证新旧生物标志物。低钠血症已再次成为CHF患者的预后标志物。
这是一项对从沙特阿拉伯胡拜尔法赫德国王大学医院招募的241例CHF患者进行的回顾性队列研究（2005年1月至2016年12月）。在基线时测量他们的血清钠和生化参数，同时进行二维超声心动图评估左心室质量和射血分数。主要终点是在24个月的随访期后低钠血症与全因死亡率（ACM）之间的关联。
患者的平均年龄为60.61±12.63（标准差）岁；65.1%为男性，71%患有2型糖尿病（DM）。基线血清钠为138.00（136，140）（中位数和四分位间距）。低钠血症（<135 meq/L）的发生率为14.1%。随访后，发生了46例死亡。多变量Cox比例风险模型显示，2型DM、纽约心脏协会（NYHA）分级（III-IV级与I-II级）、年龄和左心室质量指数（LVMI）是ACM的显著且独立的预测因素，HR分别为3.03（95%CI；1.13，8.16）（P=0.028）、HR 2.31（95%CI；1.11，4.82）（P=0.026）、HR 1.06（95%CI；1.03，1.09）（P<0.001）和HR 1.01（95%CI；1.00，1.02）（P=0.039）。估计肾小球滤过率（eGFR）不是一个显著的预测因素。采用Kaplan-Meier生存分析来分析NYHA分级和低钠血症的相互作用，结果显示低钠血症与NYHA III-IV级患者而非I-II级患者的较差生存率相关（对数秩检验，P=0.0009）。
低钠血症是CHF患者的一个特征，ACM可由2型DM、NYHA分级、年龄和LVMI预测。低钠血症对生存率的影响见于疾病更晚期的患者。
