Hyponatremia at discharge as a predictor of 12-month clinical outcomes in hospital survivors after acute myocardial infarction
Hyponatremia at discharge as a predictor of 12-month clinical outcomes in hospital survivors after acute myocardial infarction
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DOI：
10.1007/s00380-016-0854-6
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发表时间：
2017-02-01
影响因子：
1.5
通讯作者：
Chae, Shung Chull
中科院分区：
文献类型：
--
作者：
Bae, Myung Hwan;Kim, Jae Hee;Chae, Shung Chull
急性心肌梗死 (AMI) 早期的低钠血症是众所周知的预后不良的预测因素。然而，对于 AMI 后住院幸存者出院时钠水平的临床意义知之甚少。该研究纳入了 1290 名连续 AMI 后住院患者（64 +/- 12 岁；877 名男性）。我们确定了这些患者的 12 个月死亡率。在 12 个月的随访期间死亡的患者出院时的钠水平低于存活的患者（137 +/- 6 vs. 139 +/- 4 mmol/L；P < 0.014）。 210 名患者 (16.3%) 出院时出现低钠血症，定义为血清钠水平 ae135 mmol/L。在 Cox 比例风险模型中，出院时低钠血症（风险比，2.264；95% 置信区间，1.119-4.579；P = 0.023）是 12 个月死亡率的独立预测因子。此外，出院时低钠血症比传统危险因素（chi (2) = 7，P = 0.007）以及传统危险因素和 log N 末端 Pro-B 型利尿钠肽组合（chi (2) = 5，P = 0.021）具有增量预后价值。在亚组分析中，出院时出现低钠血症的患者的 12 个月死亡率显着高于未出现低钠血症的患者，无论其年龄、Killip 分级、左心室射血分数、首次住院时经皮冠状动脉介入治疗以及出院时没有服用利尿剂。出院时的低钠血症是 AMI 后住院幸存者 12 个月死亡率的独立预测因素。
Hyponatremia in the early phase of acute myocardial infarction (AMI) is a well-known predictor of poor prognosis. However, little is known about the clinical implication of sodium levels at discharge in hospital survivors after AMI. The study included 1290 consecutive patients (64 +/- 12 years; 877 men) who survived the index hospitalization after AMI. We determined the 12-month mortality rates of these patients. Patients who died during the 12-month follow-up had lower sodium levels at discharge than those who had survived (137 +/- 6 vs. 139 +/- 4 mmol/L; P < 0.014). Hyponatremia at discharge, defined as a serum sodium level ae135 mmol/L, was present in 210 patients (16.3 %). In the Cox-proportional hazard model, hyponatremia at discharge (hazard ratio, 2.264; 95 % confidence interval, 1.119-4.579; P = 0.023) was an independent predictor of 12-month mortality. Moreover, hyponatremia at discharge had an incremental prognostic value over conventional risk factors (chi (2) = 7, P = 0.007), and conventional risk factors and log N-terminal Pro-B-type natriuretic peptide combined (chi (2) = 5, P = 0.021). In the subgroup analysis, the 12-month mortality of patients with hyponatremia at discharge was significantly higher than in those without, irrespective of age, Killip class, left ventricular ejection fraction, percutaneous coronary intervention at index hospitalization, and prescription of diuretics at discharge. Hyponatremia at discharge is an independent predictor of 12-month mortality in hospital survivors after AMI.