Hyponatremia at discharge is associated with adverse prognosis in acute heart failure syndromes with preserved ejection fraction: a report from the JASPER registry
Hyponatremia at discharge is associated with adverse prognosis in acute heart failure syndromes with preserved ejection fraction: a report from the JASPER registry
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DOI：
10.1177/2048872618822459
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发表时间：
2019-10-01
影响因子：
4.1
通讯作者：
Anzai, Toshihisa
中科院分区：
文献类型：
--
作者：
Sato, Yu;Yoshihisa, Akiomi;Anzai, Toshihisa
引言：低钠血症可预测心力衰竭患者的不良预后，尤其是射血分数降低的患者。相反，最近有报道称，在射血分数保留的心力衰竭患者中，入院时低钠血症不是出院后死亡率的预测因子。我们研究了射血分数正常的心力衰竭患者出院时低钠血症对预后的影响及其临床特征。方法与结果：射血分数保留的日本心力衰竭综合征（碧玉）登记研究是一项针对射血分数保留且左心室射血分数≥ 50%的心力衰竭住院患者的全国性、观察性、前瞻性登记研究。本分析入组了500例连续患者。我们根据患者出院时的血清钠水平将患者分为两组：低钠血症组（钠135 mEq/L，n=450，90.0%）。本分析有两个主要终点：全因死亡和全因死亡或因心力衰竭再住院。出院时，低钠血症组的收缩压较低（110.0 mmHg vs. 114.5 mmHg，P=0.014），尿素氮水平较高（31.9 mg/dL vs. 24.2 mg/dL，P=0.032）。在Kaplan-Meier分析中，低钠血症组中达到主要终点的患者多于对照组（对数秩
Introduction: Hyponatremia predicts adverse prognosis in patients with heart failure in particular with reduced ejection fraction. In contrast, it has recently been reported that hyponatremia on admission is not a predictor of post-discharge mortality in patients with heart failure with preserved ejection fraction. We investigated the prognostic impact of hyponatremia at discharge in patients with heart failure with preserved ejection fraction and its clinical characteristics. Methods and results: The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, prospective registration of consecutive Japanese patients hospitalised with heart failure with preserved ejection fraction and left ventricular ejection fraction of 50% or greater. Five hundred consecutive patients were enrolled in this analysis. We divided the patients into two groups based on their sodium serum levels at discharge: hyponatremia group (sodium 135 mEq/L, n=450, 90.0%). This present analysis had two primary endpoints: all-cause death and all-cause death or rehospitalisation for heart failure. At discharge, the hyponatremia group had lower systolic blood pressure (110.0 mmHg vs. 114.5 mmHg, P=0.014) and higher levels of urea nitrogen (31.9 mg/dL vs. 24.2 mg/dL, P=0.032). In the Kaplan-Meier analysis, more patients in the hyponatremia group reached the primary endpoints than those in the control group (log rank