Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure -: Results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study
Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure -: Results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study
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DOI：
10.1161/01.cir.0000165065.82609.3d
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发表时间：
2005-05-17
期刊：
影响因子：
37.8
通讯作者：
Gheorghiade, M
中科院分区：
文献类型：
--
作者：
Klein, L;O'Connor, CM;Gheorghiade, M
背景-血清钠对因恶化心力衰竭住院患者的预后价值尚未明确。方法和结果-静脉注射米力农治疗慢性心力衰竭加重的前瞻性试验（OPTIME-CHF）研究的结果随机选择949例因心力衰竭加重而住院的收缩功能障碍患者，在标准治疗的基础上接受48至72小时静脉注射米力农或安慰剂。在回顾性分析中，我们调查了入院血清钠与随机分组后60天内心血管原因住院天数的主要终点之间的关系，以及住院死亡率、60天死亡率和60天死亡率/再住院的次要终点之间的关系。因心血管原因住院的天数在钠含量最低的四分位数中较高：8.0（4.5,18.5）天和6（4,13）天和6（4,11.5）天和6（4,12）天（与最低四分位数比较，P < 0.015）。低血清钠与较高的住院死亡率和60天死亡率相关：分别为5.9%对1%对2.3%对2.3% （P < 0.015）和15.9%对6.4%对7.8%对7% （P = 0.002）。钠含量最低的患者有更高的死亡率/再住院率的趋势。多变量校正Cox比例风险分析显示，当线性建模时，入院时血清钠预测60天死亡率增加：钠（每3 meq /L降低）的风险比为1.18,95% CI为1.03至1.36 （P = 0.018）。结论：在因心力衰竭恶化而住院的患者中，入院时血清钠是心血管原因住院天数增加和出院后60天内死亡率增加的独立预测因子。
Background - The prognostic value of serum sodium in patients hospitalized for worsening heart failure has not been well defined.Methods and Results - The Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study randomized 949 patients with systolic dysfunction hospitalized for worsening heart failure to receive 48 to 72 hours of intravenous milrinone or placebo in addition to standard therapy. In a retrospective analysis, we investigated the relationship between admission serum sodium and the primary end point of days hospitalized for cardiovascular causes within 60 days of randomization, as well as the secondary end points of in-hospital mortality, 60-day mortality, and 60-day mortality/rehospitalization. The number of days hospitalized for cardiovascular causes was higher in the lowest sodium quartile: 8.0 (4.5, 18.5) versus 6 ( 4, 13) versus 6 ( 4, 11.5) versus 6 ( 4, 12) days ( P < 0.015 for comparison with the lowest quartile). Lower serum sodium was associated with higher in-hospital and 60-day mortality: 5.9% versus 1% versus 2.3% versus 2.3% ( P < 0.015) and 15.9% versus 6.4% versus 7.8% versus 7% ( P = 0.002), respectively. There was a trend toward higher mortality/rehospitalization for patients who were in the lowest sodium quartile. Multivariable-adjusted Cox proportional hazards analysis showed that serum sodium on admission, when modeled linearly, predicted increased 60-day mortality: sodium ( per 3-mEq/L decrease) had a hazard ratio of 1.18 with a 95% CI of 1.03 to 1.36 ( P = 0.018).Conclusions - In patients hospitalized for worsening heart failure, admission serum sodium is an independent predictor of increased number of days hospitalized for cardiovascular causes and increased mortality within 60 days of discharge.