Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-03-27 Cooperative journals: 《中国全科医学》
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（n=136）and 140-145 mmol/L（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（r=-0.176），NT#2;proBNP（r=-0.135），right ventricular diameter（r=-0.110）and pulmonary artery systolic pressure（r=-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.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-07-05 Cooperative journals: 《中国全科医学》
GUO Yunting
HOU Xiaomin
BAI Jianying
CHANG Mingyang
ZHAO Xu
SUN Lin
ZHENG Zhifa
SHI Yiwei
QIN Xiaojiang
Abstract： Background Pulmonary hypertension（PH） is often caused by left heart disease（group 2 PH），which is difficult to diagnose early and with a high mortality rate. Potassium channel dysfunction is a marker of PH，however，the epidemiological data of the disease and the effect of potassium ions on PH still remain unclear. Objective To investigate the correlation of serum potassium level with myocardial markers，echocardiographic indicators and length of hospital stay in patients with group 2 PH，and evaluate the predictive value of serum potassium levels for the severity of group 2 PH，so as to provide the oretical basis for clinical diagnosis and treatment. Methods The clinical data of 400 adult inpatients diagnosed with group 2 PH in the First Hospital of Shanxi Medical University from January 2020 to December 2021 were retrospectively collected as follows：（1） general data：gender，age，body mass index（BMI），length of hospital stay，smoking status，smoking index（SI）and drinking history；（2）underlying diseases（diabetes mellitus，hypertension）；（3） laboratory data：serum potassium level，myocardial markers〔procalcitonin，N-terminal pro-brain natriuretic peptide（NT-proBNP），cardiac troponin I，cardiac troponin T，creatine kinase-MB〕，echocardiographic indicators（left atrial diameter，right ventricular diameter，right atrial area，left ventricular ejection fraction，shortening fraction，peak tricuspid regurgitation velocity，pulmonary artery systolic pressure）. The patients were divided into <3.5 mmol/L group（n=57），3.5-5.5 mmol/L group（n=340）and >5.5 mmol/L group（n=3）according to the serum potassium level.Spearman correlation analysis was used to explore the correlation of serum potassium level with myocardial markers and echocardiographic indicators. Log-rank （Mantel-Cox） test was used to compare the discharge rate of patients with different serum potassium levels. Receiver operating characteristic curve （ROC curve） was plotted to evaluate the predictive value of serum potassium level for the severity of group 2 PH. Results Procalcitonin and NT#2;proBNP levels of patients in the hyperkalemia group were significantly higher than the hypokalemia group（P<0.05）. Correlation analysis showed that serum potassium level was positively correlated with NT-proBNP（rs=0.133），peak tricuspid regurgitation velocity（rs=0.017） and pulmonary artery systolic pressure （PASP）（rs=0.126）（P<0.05）. Serum potassium level was further classified as <3.5 mmol/L，3.0-3.5 mmol/L，4.0-4.9 mmol/L，5.0-5.5 mmol/L，and>5.5 mmol/L to investigate its relationship with length of hospital stay in depth. Log-rank （Mantel-Cox） testresults showed that for group 2 PH patients greater than average hospitalization levels，there was a significant difference in cumulative hospitalization rates among patients with different serum potassium levels（<3.5 mmol/L，3.5-3.9 mmol/L，4.0-4.9 mmol/L，5.0-5.5 mmol/L，>5.5 mmol/L）（P=0.022）. ROC analysis showed that the diagnostic value of serum potassium level for non-mild PH（AUC=0.577，cut-off value=3.91 mmol/L，sensitivity=64.7%，specificity=52.5%） was similar to that of NT-proBNP（AUC=0.585，cut-off value=1 070.69 pg/mL，sensitivity=78.1%，specificity=39.6%），which can effectively predict the severity of group 2 PH. Conclusion Serum potassium level can predict the severity of group 2 PH and the length of hospital stay. Intervention of serum potassium levels may be one of the new approach to prevent and treat PH.
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