Department of General Medicine, University Hospital Geelong, Barwon Health, Bellerine Street, Geelong, VIC, 3220, Australia.
IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia.
BMC Cardiovasc Disord. 2022 Sep 2;22(1):391. doi: 10.1186/s12872-022-02830-3.
Lower urinary sodium concentrations (U) may be a biomarker for poor prognosis in chronic heart failure (HF). However, no data exist to determine its prognostic association over the long-term. We investigated whether U predicted major adverse coronary events (MACE) and all-cause mortality over 28-33 years.
One hundred and eighty men with chronic HF from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) were included. Baseline data was collected between 1984 and 1989. MACE and all-cause outcomes were obtained using hospital linkage data (1984-2017) with a follow-up of 28-33 years. Cox proportional hazards models were generated using 24-h U tertiles at baseline (1 ≤ 173 mmol/day; 2 = 173-229 mmol/day; 3 = 230-491 mmol/day) as a predictor of time-to-MACE outcomes, adjusted for relevant covariates.
Overall, 63% and 83% of participants (n = 114 and n = 150) had a MACE event (median 10 years) and all-cause mortality event (median 19 years), respectively. On multivariable Cox Model, relative to the lowest U tertile, no significant difference was noted in MACE outcome for individuals in tertiles 2 and 3 with events rates of 28% (HR:0.72; 95% CI: 0.46-1.12) and 21% (HR 0.79; 95% CI: 0.5-1.25) respectively.. Relative to the lowest U tertile, those in tertile 2 and 3 were 39% (HR: 0.61; 95% CIs: 0.41, 0.91) and 10% (HR: 0.90; 95% CIs: 0.62, 1.33) less likely to experience to experience all-cause mortality. The multivariable Cox model had acceptable prediction precision (Harrell's C concordance measure 0.72).
U was a significant predictor of all-cause mortality but not MACE outcomes over 28-33 years with 173-229 mmol/day appearing to be the optimal level. U may represent an emerging long-term prognostic biomarker that warrants further investigation.
下尿路钠浓度（U）可能是慢性心力衰竭（HF）预后不良的生物标志物。然而，目前还没有数据确定其在长期内的预后相关性。我们研究了 U 在 28-33 年内是否预测主要不良心脏事件（MACE）和全因死亡率。
180 名来自库奥皮奥缺血性心脏病危险因素研究（KIHD）的慢性 HF 男性患者被纳入研究。基线数据于 1984 年至 1989 年之间收集。使用医院链接数据（1984-2017 年）获得 MACE 和全因结局，并进行了 28-33 年的随访。使用 24 小时 U 三分位数（1 = 173 mmol/天以下；2 = 173-229 mmol/天；3 = 230-491 mmol/天）作为预测时间到 MACE 结局的指标，生成 Cox 比例风险模型，并对相关协变量进行调整。
总体而言，63%（n=114）和 83%（n=150）的参与者在中位数为 10 年（MACE 事件）和中位数为 19 年（全因死亡率事件）时发生了 MACE 事件。在多变量 Cox 模型中，与最低 U 三分位数相比，三分位 2 和 3 中的个体的 MACE 结局没有显著差异，事件发生率分别为 28%（HR：0.72；95% CI：0.46-1.12）和 21%（HR 0.79；95% CI：0.5-1.25）。与最低 U 三分位数相比，三分位 2 和 3 的个体发生全因死亡率的风险分别降低了 39%（HR：0.61；95% CIs：0.41，0.91）和 10%（HR：0.90；95% CIs：0.62，1.33）。多变量 Cox 模型具有可接受的预测精度（Harrell's C 一致性度量为 0.72）。
U 是全因死亡率而不是 MACE 结局的重要预测指标，但在 28-33 年内，173-229 mmol/天似乎是最佳水平。U 可能代表一种新的长期预后生物标志物，值得进一步研究。
