Zhongguo quanke yixue (Mar 2025)
Relationship between Serum Sodium Levels and Length of Hospital Stay in Patients with Pulmonary Hypertension associated with Left Heart Disease
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.
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