| Objective: By observing the clinical characteristics and analysis of related factors of patients with AECOPD complicated with hyponatremia,the influence of hyponatremia on the prognosis of PATIENTS with AECOPD was explored,so as to improve the attention of clinicians to hyponatremia.Methods: A total of 320 patients,208 males and 112 females,who were admitted to the Respiratory Department of The Affiliated Hospital of Yan ’an University from January 2019 to December 2019 and met the criteria of natremia were collected.According to the results of serum sodium at admission,< 137mmol/L was defined as hyponatremia.All AECOPD patients were divided into hyposodium group(83 cases)and non-hyponatremia group(237 cases).Gender,age,smoking history,BMI,length of stay,arterial blood gas,blood routine,PCT,pro-BNP,blood clotting related indicators,electrolytes,renal function,cardiac enzymes,liver function,lung function,complications,nasal catheter oxygen inhalation,nasal high-flow oxygen therapy,non-invasive ventilator assisted ventilation at admission were collected.Finally,the death of the patients during hospitalization,re-hospitalization and death were recorded by digital medical record browsing system and telephone follow-up within 1 year after discharge.SPSS22.0 software was used for data processing,and the incidence of hyponatreemia in AECOPD patients of different genders and ages was statistically analyzed.All clinical data of the two groups were compared.Spearman was used to analyze the relationship and closeness between relevant indicators and serum sodium,and the influence of hyponatreemia on prognosis of AECOPD patients was analyzed after adjusting confounding factors.Results:1.Among 320 AECOPD patients,the mean age was(71.71±9.31)years,83 patients were complicated with hyponatremia,the mean age was(75.04±7.67)years,and the prevalence of hyponatremia was 25.94%.In different genders,the prevalence rate was 26.44% in males and 25% in females,with no significant difference(P > 0.05).At different ages: The prevalence of hyponatremia at(< 65),(65-74),(75-84)and(≥85)years was 7.35%,25.38%,36.46% and 38.46%,respectively.There was statistical difference between the prevalence of hyponatremia at(< 65)years and the other three groups(P < 0.05).There was no significant difference in the prevalence of(65-74)years,(75-84)years and(≥85)years(P > 0.05).2.In general data,the average age of the hyponatremia group was higher than that of the non-hyponatremia group(P < 0.05),BMI was lower than that of the non-hyponatremia group(P < 0.05),and hospital stay was longer than that of the non-hyponatremia group(P < 0.05).There were no statistical differences in gender and smoking history(P > 0.05).Arterial blood gas results showed that there were no significant differences in PH,Pa CO2,Pa O2,HCO3-and respiratory failure between the hyponatraemia group and the non-hyponatraemia group(P > 0.05).Blood routine results showed that WBC,NEU,NLR and PLR in hyponatremia group were higher than those in non-hyponatremia group(P < 0.05),but there was no statistical difference in Hb between hyponatremia group(P > 0.05).Blood coagulation results showed that the levels of FIB,FDP and Plasma D-dimer in the hyponatremia group were higher than those in the non-hyponatremia group(P < 0.05).Electrolyte results showed that the hyposodium group was more likely to be complicated with hypochloremia,hypocalcemia and hypophosphatemia than the non-hyponatremia group(P < 0.05),but there was no statistical difference in the combination of hypokalemia and hypomagnesemia(P > 0.05).In terms of renal function and myocardial enzymes,the CYS-C and LD in hyponatremia group were higher than those in non-hyponatremia group(P < 0.05),while there were no significant differences in UN,CRE and CK between the two groups(P > 0.05).The results of liver function showed that TP and Alb in hyponatremia group were lower than those in non-hyponatremia group(P < 0.05),but there were no significant differences in ALT,AST,ALP and GGT(P > 0.05).Pro-bnp and PCT in hyponatremia group were higher than those in non-hyponatremia group(P < 0.05).The results of lung function showed that FVC,FEV1 and PEF in the hyposodium group were lower than those in the non-hyposodium group(P < 0.05).In terms of complications,the probability of pneumonia in hyponatremia group was higher than that in non-hyponatremia group(P <0.05),but there was no significant difference in atrial fibrillation,arrhythmia,chronic gastritis,old tuberculosis,coronary heart disease,diabetes,hypertension,cerebral infarction,bronchiectasis and pleural effusion between the two groups(P > 0.05).In terms of post-admission treatment,the hyponatremia group had a higher rate of nasal high-flow oxygen therapy(P < 0.05),while the non-hyponatremia group had a higher rate of nasal catheter oxygen uptake(P < 0.05).There was no statistical significance in non-invasive ventilator-assisted ventilation between the two groups(P > 0.05).In terms of clinical prognosis,the mortality during hospitalization in the hyponatremia group was higher than that in the non-hyponatremia group(P < 0.05),and the acute aggravation hospitalization rate and all-cause mortality within 1 year after discharge were higher than those in the non-hyponatremia group(P < 0.05).3.Spearman rank correlation analysis found that: BMI,Alb,FVC,FEV1 and PEF were positively correlated with serum sodium(correlation coefficients were 0.24,0.26,0.2,0.25,0.12,P < 0.05).Age,length of stay,LD,Pro-BNP,WBC,NEU,NLR,PLR,PCT,FIB,FDP,plasma D-dimer were negatively correlated with serum sodium(correlation coefficients were-0.22,-0.15,-0.33,-0.17,-0.26,-0.28,-0.34,-0.22,respectively),-0.24,-0.21,-0.26,-0.32,P < 0.05).4.After adjusting for confounding factors such as age,BMI,and respiratory failure,there was a statistically significant association between admission hyponatremia and poor prognosis in patients with AECOPD(OR=3.869,95%CI 2.111-7.094,P < 0.001).Conclusion:1.In patients with AECOPD,the elderly are more prone to hyponatremia.2.Patients with AECOPD in the hyponatremia group had longer hospital stay,higher in-hospital mortality,acute exacerbation rehospitalization within 1 year afterdischarge,and higher all-cause mortality.3.Hyponatremia is associated with poor prognosis in patients with AECOPD. |
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