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心力衰竭患者入院时血清钠水平对1年内再入院预测价值研究
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Abstract:
背景：心力衰竭(心衰)是常见的一种慢性疾病，随着社会的进步与发展，影响心衰的因素也研究了很多，但对于心衰患者入院时血清钠的水平对1年内再入院的预测价值尚有争议。目的：分析心衰患者血清钠的水平与1年内再入院的关系。方法：这项研究是一项回顾性队列研究。所有心衰住院患者的数据均来自PhysioNet数据库。该数据库整合了中国四川省自贡市第四人民医院2016年12月至2019年6月期间收治的2008名诊断为心衰患者的咨询记录和随访数据。我们分析了因心衰入院治疗的876例心衰患者的临床资料，同时根据入院的血清钠水平分为三组：低血清钠组(107.5~136.8 mmol/L, n = 292)、中血清钠组(136.9~140 mmol/L, n = 285)和高血清钠组(140.1~154 mmol/L, n = 299)。采用Cox回归、分层分析和阈值效应分析、KM曲线，探究血清钠与心衰患者1年内再入院之间的关联性。结果：在阈值分析中，血清钠每增加1mmol/L，心衰患者1年内再入院的风险显著降低3%，风险比(HR)及其95% CI为0.97 (0.94~0.99)。使用三个模型分析不同血钠水平的患者，校正后，高钠组相对于低钠组和中钠组风险较低，结果事件存在显著差异，HR及其95% CI分别为0.69 (0.58~0.81, P < 0.001)、0.70 (0.59~0.83, P < 0.001)和0.72 (0.57~0.92, P = 0.007)。亚组分析显示，血清钠水平对结果事件有稳定的影响，不受协变量(性别、年龄、身体质量指数(BMI)、糖尿病、慢性肾脏病(CKD)、心肌梗死、慢性阻塞性肺疾病(COPD)、利尿剂、肌酐、尿酸、钾、氯、N末端B型利钠肽原)的影响。结论：血清钠与心衰患者1年内再入院的结局事件呈负相关。较高的血清钠会使心衰患者1年内再入院的风险降低。因此，首次住院时血清钠的水平可能是一个心衰患者再入院有价值的预测因素。
Background: Heart failure is a common chronic disease, and with the progress and development of society, many factors affecting heart failure have been studied, but there is still controversy about the predictive value of serum sodium levels at the time of admission to hospitals for patients with heart failure to be readmitted to the hospital within 1 year. Objectives: To analyze the association between serum sodium level and readmission within 1 year in patients with heart failure. Methods: This study was a retrospective cohort study. Data on all heart failure hospitalizations came from the PhysioNet Limited Health Data database. The database integrates consultation records and follow-up data of 2008 patients diagnosed with heart failure admitted to the Fourth People’s Hospital of Zigong City, Sichuan Province, China, between December 2016 and June 2019. We analyzed the clinical data of 876 patients with heart failure who were admitted to hospital for treatment of heart failure and were divided into three groups according to the serum sodium level at admission: low serum sodium group (107.5~136.8 mmol/L, n = 292), medium serum sodium group (136.9~140 mmol/L, n = 285) and high serum sodium group (140.1~154mmol/L, n = 299). Cox regression, stratified analysis, threshold effect analysis and Kaplan-Meier survival curve were used to study the association between serum sodium and readmission of patients with heart failure within 1 year. Results: In the threshold analysis, for every 1 mmol/L increase in serum sodium, the risk of readmission within 1 year was significantly reduced by 3%, and the hazard ratio (HR) and 95% CI were 0.97 (0.94~0.99). After three models were used to analyze patients with different serum sodium levels,
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