Progression of Hyponatremia is Associated With Increased Cardiac Mortality in Patients Hospitalized for Acute Decompensated Heart Failure

Konishi, Masanori; Haraguchi, Go; Ohigashi, Hirokazu; Sasaoka, Taro; Yoshikawa, Shunji; Inagaki, Hiroshi; Ashikaga, Takashi; Isobe, Mitsuaki

doi:10.1016/j.cardfail.2012.06.415

Cited by 50 publications

(33 citation statements)

References 22 publications

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“…The degree of hyponatremia habitually parallels the severity of cardiac dysfunction and is further exacerbated by any reduction in GFR and arginine vasopressin dysregulation. Recently, Konishi et al [28] demonstrated that progression to hypo-natremia during hospitalization is a robust predictor of poor cardiac prognosis in AHF patients who were normonatremic at admission. Regarding the factors associated with 1-year mortality in our patients, beyond older age, lower systolic blood pressure, sodiemia lower than 136 mEq/l and abnormal status of consciousness (four communal in-hospital and 1-year mortality predictors), there were other three chief prognosticators which emerged by multivariable Cox regression analysis.…”

Section: Discussionmentioning

confidence: 98%

Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome

Cioffi

Mortara

Lenarda

et al. 2013

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 98%

Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome

Cioffi

Mortara

Lenarda

et al. 2013

International Journal of Cardiology

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“…In a subanalysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure registry, on admission, hyponatremia has been reported in ∼20% patients with ADHF 4. 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…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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AimsA considerable proportion of hospitalized patients for acute decompensated heart failure will be readmitted or die in short‐term follow‐up. In the present study, we aimed to assess the role of admission sodium (Na) and uric acid (UA) levels in the prediction of 30 day post‐discharge heart failure readmission or all‐cause mortality in advanced heart failure patients admitted with acute decompensation.Methods and resultsOne hundred and forty consecutive advanced heart failure patients who were admitted for a recent cardiac decompensation were enrolled in this prospective study. Serum Na and UA levels remained statistically unchanged during index admission (P = 0. 54 and 0.19, respectively). Within 30 days post‐discharge, composite end point of heart failure rehospitalization or all‐cause death occurred in 62 (44.3%) patients (event group). Length of stay was statistically similar between patients in the event and non‐event groups (P = 0.38). No correlations were also found between length of stay and left ventricular ejection fraction, serum Na, UA, erythrocyte sedimentation rate (ESR), high‐sensitivity C‐reactive protein (hs‐CRP), creatinine, and N‐terminal pro b‐type natriuretic peptide (NT‐proBNP) levels (all P > 0.05). Lower left ventricular ejection fraction and Na and higher UA on admission were significantly associated with 30 day event both in univariate and multivariate analyses.ConclusionsGiven the predictive role of baseline Na and UA for early post‐discharge outcome and the absence of significant changes in their levels during initial hospitalization, admission Na and UA can be considered as prognosticators of acute decompensated heart failure, which their prognostic significance cannot be affected by routine acute heart failure therapy.

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“…It is present in ∼20% of patients admitted with acute heart failure and develops during decongestive treatment in an additional ∼15-25% [1, 2, 3]. Hyponatremia in heart failure is associated with worse outcomes and increased mortality, especially when persistent [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Transient Hyponatremia During Hospitalization for Acute Heart Failure

Verbrugge

Grodin

Mullens

et al. 2016

The American Journal of Medicine

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Objective To study whether the temporal pattern of transient hyponatremia development in acute heart failure might provide insight into its pathophysiology and prognostic relevance. Methods A post-hoc analysis of the ESCAPE and DOSE AHF studies was performed (n=716). Patients were stratified according to the temporal pattern of hyponatremia development: (1) no hyponatremia; (2) persistent hyponatremia; (3) decompensation hyponatremia disappearing with decongestive treatment; and (4) treatment-induced hyponatremia. Results Transient decompensation versus no hyponatremia was associated with significantly elevated blood urea nitrogen/creatinine ratio (P-value<0.001), plasma renin activity (P-value<0.001), and plasma aldosterone levels (P-value<0.001) at baseline. Disease severity characteristics of such patients were intermediate between no and persistent hyponatremia. In contrast, patients with treatment-induced versus no hyponatremia had similar baseline characteristics, comparable natriuretic peptide levels, and both groups had little neurohumoral activation at baseline. Diuretic efficacy, defined as net fluid balance [mL] per 40 mg furosemide-equivalent dose administered, was lower in patients with persistent or treatment-induced hyponatremia versus decompensation hyponatremia or no hyponatremia, respectively. The former versus latter groups also had more pronounced neurohumoral activation with decongestive treatment. The risk for all-cause mortality [HR (95%CI) = 2.50 (1.50-4.19); P-value<0.001] and death or heart failure readmission [HR (95%CI) = 2.18 (1.60-2.97); P-value<0.001] was significantly elevated in patients with persistent versus no hyponatremia, with the risk of decompensation and treatment-hyponatremia situated in-between. Conclusions Transient hyponatremia is prognostically relevant, but has a heterogeneous etiology according to its temporal pattern of development.

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Progression of Hyponatremia is Associated With Increased Cardiac Mortality in Patients Hospitalized for Acute Decompensated Heart Failure

Cited by 50 publications

References 22 publications

Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome

Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome

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

Transient Hyponatremia During Hospitalization for Acute Heart Failure

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