Chinese General Practice ›› 2025, Vol. 28 ›› Issue (09): 1065-1071.DOI: 10.12114/j.issn.1007-9572.2023.0889

• Original Research • Previous Articles     Next Articles

Relationship between Serum Sodium Levels and Length of Hospital Stay in Patients with Pulmonary Hypertension associated with Left Heart Disease

  

  1. 1. School of Public Health, Shanxi Medical University, Taiyuan 030001, China
    2. First Hospital of Shanxi Medical University, Taiyuan 030001, China
    3. College of Basic Medical College, Shanxi Medical University, Taiyuan 030001, China
  • Received:2024-01-07 Revised:2024-03-12 Published:2025-03-20 Online:2025-01-02
  • Contact: QIN Xiaojiang

左心疾病相关肺动脉高压患者血钠水平与住院时间的相关性研究

  

  1. 1.030001 山西省太原市,山西医科大学公共卫生学院
    2.030001 山西省太原市,山西医科大学第一医院
    3.030001 山西省太原市,山西医科大学基础医学院
  • 通讯作者: 秦小江
  • 作者简介:

    作者贡献:

    孙琳、秦小江提出文章总体研究目标,负责研究设计;孙琳进行数据的整理分析与解释,并撰写论文;孙琳、郭耘廷、赵旭、董霖负责数据收集、整理及录入;施熠炜、侯晓敏、聂继盛负责质量控制及论文修改;秦小江负责监督研究的实施,文章的质控及审校,对文章整体负责。

  • 基金资助:
    国家自然科学基金面上项目(82373622); 国家自然科学基金青年基金项目(82204042); 国家卫生健康委员会尘肺病重点实验室开放课题(YKFKT006,NHC202307); 山西省留学人员科技活动择优资助项目重点项目(20220019); 山西省科技合作交流专项项目区域合作项目(202204041101022); 山西省科技创新人才团队专项项目(202304051001038); 中央级公益性科研院所科研业务项目(2020-PT320-005)

Abstract:

Background

Pulmonary hypertension (PH) associated with left heart disease (PH-LHD) is the most common form of PH. Studies have shown that serum sodium is associated with the severity and poor prognosis of group 1 PH, but the effect of serum sodium on PH-LHD has rarely been reported.

Objective

To investigate the relationship between serum sodium and N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiographic indexes in PH-LHD patients, and evaluate the effect of serum sodium on the severity and length of stay of PH-LHD, so as to provide theoretical basis for clinical diagnosis and treatment of PH-LHD patients and improvement of hospital turnover.

Methods

The clinical data of 360 adult inpatients diagnosed with PH-LHD in the First Hospital of Shanxi Medical University from January 2020 to February 2022 were collected. According to the median serum sodium of 139 mmol/L (serum sodium <135 mmol/L is hyposodium), the patients were divided into 3 groups: <135 mmol/L group (n=50), 135-139 mmol/L group (n=136) and 140-145 mmol/L group (n=174). Spearman correlation analysis was used to explore the correlation of serum sodium level with length of hospital stay, NT-proBNP and echocardiographic indicators. Kaplan-Meier was used to compare the length of hospital stay of PH-LHD patients with different serum sodium levels. Binary Logistic regression analysis was used to investigate the effect of serum sodium levels on the length of hospital stay in PH-LHD patients.

Results

Age, length of stay, NT-proBNP, left atrial diameter, right atrium area, left ventricular ejection fraction and shortening fraction of PH-LHD patients in 3 groups were compared, and the differences were statistically significant (P<0.05). The length of hospitalization and NT-proBNP of patients in the serum sodium 140-145 mmol/L group were lower than those in the serum sodium <135 mmol/L group and the serum sodium 135-139 mmol/L group (P<0.05). Spearman correlation analysis showed that serum sodium level was negatively correlated with length of stay (rs=-0.176), NT-proBNP (rs=-0.135), right ventricular diameter (rs=-0.110) and pulmonary artery systolic pressure (rs=-0.105) in PH-LHD patients (P<0.05). The Kaplan-Meier survival showed that there were statistically significant differences between the length of hospital stay among the three groups of PH-LHD patients with different serum sodium levels. Binary Logistic regression analysis showed that increased serum sodium level was a protective factor for longer hospital stay in PH-LHD patients after correcting each control variable (OR=0.916, 95%CI=0.859-0.977, P=0.008). The risk of prolonged hospitalization was elevated in patients with serum sodium <135 mmol/L and those with serum sodium 135-139 mmol/L compared with patients with serum sodium 140-145 mmol/L.

Conclusion

Serum sodium level is closely related to the severity of PH-LHD, and decreased serum sodium level is an independent risk factor for the length of hospital stay in PH-LHD patients. It is a potential therapeutic consideration, providing new strategies for the diagnosis and treatment of PH-LHD and hospital turnover.

Key words: Pulmonary arterial hypertension, Pulmonary hypertension associated with left heart disease, Serum sodium, Echocardiography, Length of stay, Logistic models

摘要:

背景

左心疾病相关肺动脉高压(PH-LHD)是肺动脉高压(PH)中较常见的一种。研究表明,血钠水平与1类PH的严重程度和不良预后相关,然而,其对PH-LHD的影响鲜有报道。

目的

探讨PH-LHD患者的血钠水平与N末端脑利钠肽前体(NT-proBNP)、超声心动图指标的关系,评价血钠水平对PH-LHD严重程度及住院时间的影响,为PH-LHD患者的临床诊疗及提高医院周转率提供理论依据。

方法

回顾性收集2020年1月—2022年2月在山西医科大学第一医院住院的360例PH-LHD患者的临床资料,依据患者的中位血钠水平139 mmol/L(血钠<135 mmol/L为低血钠)将患者分为3组:血钠<135 mmol/L组(50例)、血钠135~139 mmol/L组(136例)、血钠140~145 mmol/L组(174例)。采用Spearman秩相关分析探讨血钠水平与住院时间、NT-proBNP及超声心动图指标的相关性;采用Kaplan-Meier生存曲线分析比较不同血钠水平PH-LHD患者的住院时间;采用二元Logistic回归分析探讨血钠水平对PH-LHD患者住院时间的影响。

结果

3组PH-LHD患者年龄、住院时间、NT-proBNP、左心房前后径、右心房面积、左心室射血分数、缩短分数比较,差异有统计学意义(P<0.05);其中血钠140~145 mmol/L组患者的住院时间、NT-proBNP低于血钠<135 mmol/L组及血钠135~139 mmol/L组(P<0.05)。Spearman秩相关分析结果显示,PH-LHD患者血钠水平与住院时间(rs=-0.176)、NT-proBNP(rs=-0.135)、右心室前后径(rs=-0.110)、肺动脉收缩压(rs=-0.105)均呈负相关(P<0.05)。Kaplan-Meier生存曲线分析结果显示,3组血钠水平的PH-LHD患者住院时间比较,差异有统计学意义(χ2=12.469,P=0.002)。二元Logistic回归分析校正各控制变量后结果显示,血钠水平升高是PH-LHD患者住院时间延长的保护因素(OR=0.916,95%CI=0.859~0.977,P=0.008);与血钠140~145 mmol/L患者相比,血钠<135 mmol/L(OR=2.268,95%CI=1.049~4.903,P=0.037)及血钠135~139 mmol/L(OR=2.056,95%CI=1.163~3.635,P=0.013)患者住院时间延长的风险均升高。

结论

血钠水平与PH-LHD严重程度密切相关,血钠水平降低是PH-LHD患者住院时间延长的独立危险因素,是一种潜在的治疗考虑因素,可为PH-LHD的诊疗及医院周转提供新策略。

关键词: 肺动脉高压, 左心疾病相关肺动脉高压, 血钠, 超声心动图, 住院时间, Logistic模型

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