Lower Serum Sodium Is Associated With Increased Short-Term Mortality in Hospitalized Patients With Worsening Heart Failure

Abstract

MD; for the OPTIME-CHF InvestigatorsBackground-The prognostic value of serum sodium in patients hospitalized for worsening heart failure has not been well defined. Methods and Results-The Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic HeartFailure (OPTIME-CHF) study randomized 949 patients with systolic dysfunction hospitalized for worsening heart failure to receive 48 to 72 hours of intravenous milrinone or placebo in addition to standard therapy. In a retrospective analysis, we investigated the relationship between admission serum sodium and the primary end point of days hospitalized for cardiovascular causes within 60 days of randomization, as well as the secondary end points of in-hospital mortality, 60-day mortality, and 60-day mortality/rehospitalization. The number of days hospitalized for cardiovascular causes was higher in the lowest sodium quartile: 8.0 (4.5, 18.5) versus 6 (4, 13) versus 6 (4, 11.5) versus 6 (4, 12) days (PϽ0.015 for comparison with the lowest quartile). Lower serum sodium was associated with higher in-hospital and 60-day mortality: 5.9% versus 1% versus 2.3% versus 2.3% (PϽ0.015) and 15.9% versus 6.4% versus 7.8% versus 7% (Pϭ0.002), respectively. There was a trend toward higher mortality/rehospitalization for patients who were in the lowest sodium quartile. Multivariable-adjusted Cox proportional hazards analysis showed that serum sodium on admission, when modeled linearly, predicted increased 60-day mortality: sodium (per 3-mEq/L decrease) had a hazard ratio of 1.18 with a 95% CI of 1.03 to 1.36 (Pϭ0.018). Conclusions-In patients hospitalized for worsening heart failure, admission serum sodium is an independent predictor of increased number of days hospitalized for cardiovascular causes and increased mortality within 60 days of discharge.

On admission serum sodium and uric acid levels predict 30 day rehospitalization or death in patients with acute decompensated heart failure

“…Accordingly, a growing body of research is trying to characterize this population of patients who are at increased risk of early post‐discharge mortality and hospitalization. Presumed prognosticators comprise a wide range of history and physical examination findings, laboratory measurements, electrocardiographic and echocardiographic indices, and ultrasound assessments and include anaemia, diabetes mellitus, new sustained arrhythmias, non‐use of neurohormonal antagonists, presence of coronary heart disease (CHD), jugular venous distension, admission systolic blood pressure, serum albumin levels, lymphocyte counts, troponin release, blood urea nitrogen (BUN) and BUN/creatinine ratio, natriuretic peptides, 6‐min walk distance (6MWD), LVEF, pulmonary capillary wedge pressure, diameter of inferior vena cava, and diuretic response and hemoconcentration during hospitalization among many others 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28. However, there is no general consensus regarding the majority of these indices, and application of most of them is subject to several disadvantages in routine clinical practice.…”

“…Moreover, hospital‐acquired hyponatremia has been reported to occur in approximately 15–25% ADHF patients as a result of decongestive treatment 5, 6. Whatever the aetiology, hyponatremia has been suggested as a predictor of short‐term outcomes in hospitalized patients with worsening HF 7, 8, 9…”

Demographical and clinicopathological characteristics in heart failure and outcome predictors: a prospective, observational study

“…Whether bendopnea will become a future surrogate of poor outcomes in HF needs further intense research. Dyselectrolytemia in HF, which includes both hyponatraemia and hypokalaemia, has been studied intensely in HF and has been associated with worse outcomes 19, 20. Hence, identifying and managing the same are very important in improving HF outcomes.…”

Hyponatraemia: new associations and new treatments

“…Severe hyponatraemia (!125 mmol/l) has been reported to be associated with in-hospital mortality of between 23 and 50% according to the plasma sodium concentration at presentation (17), and also with increased mortality at 6-month follow-up (11). Hyponatraemia has also been associated with increased mortality in the elderly (18), in heart failure (19), in pneumonia (20) and in intensive care patients (21). A recent paper presented data from a large cohort of 98 000 patients prospectively studied with outcomes measured up to 5 years after discharge from hospital.…”