| Objective:To study the correlation between baseline serum sodium and clinical features and prognosis of patients with Chronic Heart Failure(CHF).Methods:824 patients with CHF hospitalized in the Heart Disease Center of our hospital(2021.01-2021.12)were selected,and 104 patients with hyponatremia in CHF were continuously collected and included in the hyponatremia group,and 127 patients with CHF in normal serum sodium during the study period were randomly selected for inclusion in the normal sodium group.After Comparing the clinical features of the two groups,Kaplan-Meier survival curve was used to compare the cumulative survival rate between the two groups;COX regression models were used to assess the predictors affecting all cause mortality in CHF;Using ROC curve to evaluate the predictive value of blood Na~+and other factors to prognosis of CHF.Results:(1)Clinical characteristics:(1)Patients in the hyponatremia group had faster heart rate,lower systolic pressure and BMI,as well as higher proportion of severe cardiac insufficiency(NYHA Grade IV)at admission than those in the other group.(2)Both the levels of hemoglobin and serum albumin were lower in the hyponatremia group,while the levels of serum K~+,urea nitrogen,creatinine,uric acid,and NT-pro BNP were lower in the Na~+normal group.(3)The proportion of patients with CHF in the hyponatremia group using neoactivin was lower than that in the normal sodium group,while the proportion of patients using diuretics,tovaptan was higher;(2)Comparison of prognosis:(1)Patients in the hyponatremia group had longer hospitalization days and higher rates of admission to the cardiac intensive care unit;(2)During a follow-up period of(16.5±7.2)months,55 patients died,including 32 in the hyponatremia group and 23 in the normal Na~+group.The all-cause mortality rate of heart failure in the hyponatremia group was higher than that in the normal sodium group;Comparison of readmission within 1 year after discharge showed that the readmission rate of patients with hyponatremia was higher than the other group;(3)Kaplan-meier survival curve showed that the survival rate of patients with hyponatremia was significantly lower than that of the normal sodium group;(4)After adjusting for confounding factors,multivariate COX regression analysis showed that serum Na~+and NT-pro BNP were independent predictors of all cause mortality in CHF(P<0.05).Every decrease of serum Na+concentration by 1mmol/L increased the risk of all-cause death of heart failure by 0.067 times(HR=0.932,95%CI 0.874-0.995,P=0.028).Every 1pg/ml increase in NT-pro BNP concentration increased the risk of all-cause death of heart failure by 0.329times(HR=1.329,95%CI 1.006-1.755,P=0.045).(5)ROC curve displayed that the AUC of Na+for predicting the occurrence of death in CHF was0.641(95%CI:0.554-0.728,P=0.002),with a cut-off value of Na~+=134.55mmol/L;a sensitivity of 0.564 and a specificity of 0.693;and the AUC,sensitivity,specificity of NT-pro BNP for predicting the morality of CHF were 0.672,0.964 and 0.318 respectively(95%CI:0.593-0.750,P<0.001),with a cut-off value of NT-pro BNP=938 pg/ml.The AUC of the combined assessment of CHF prognosis was 0.700,,higher than Na~+or NT-pro BNP;Conclusion:CHF patients with hyponatremia have more worse heart function with a poor prognosis;Serum Na~+is an important protective factor for the prognosis of patients with heart failure.The combined assessment of serum Na~+and NT-pro BNP can improve the predictive value of prognosis in heart failure. |
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