Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure patients with preserved and with reduced ejection fraction: an individual patient data meta‐analysis†

Whalley, Gillian A.; Ruşinaru, Dan; Tribouilloy, Christophe; Berry, Colin; Richards, Ann; Earle, Nikki; Poppe, Katrina; Guazzi, Marco; Macin, Stella M.; Komajda, M; Doughty, Robert N.

doi:10.1093/eurjhf/hfs099

Cited by 109 publications

(96 citation statements)

References 31 publications

(49 reference statements)

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“…Similar associations were reported by previous smaller studies 13, 15, 16. For example, Rosinaru and colleagues15 showed that among 358 patients with HFpEF who survived a first hospitalization for HF during 7‐year follow‐up, hyponatremia (defined as serum sodium <136 mEq/L) was associated with an 87% higher risk of mortality (HR, 1.87; 95% CI, 1.40–2.52) compared with serum sodium >136 mEq/L.…”

Section: Discussionsupporting

confidence: 92%

“…In previous studies, the prevalence of hyponatremia (serum sodium <135 mmol/L) among patients with HFpEF ranged from 11% to 14% 13, 16. The exact prevalence of low‐normal serum sodium is unknown, but in a study conducted by Kusaka and colleagues14 the prevalence of low‐normal serum sodium between 135 and 140 mmol/L was 47%, which was associated with higher HF‐related events compared with serum sodium more than 140 mmol/L.…”

Section: Discussionmentioning

confidence: 98%

“…For example, Rosinaru and colleagues15 showed that among 358 patients with HFpEF who survived a first hospitalization for HF during 7‐year follow‐up, hyponatremia (defined as serum sodium <136 mEq/L) was associated with an 87% higher risk of mortality (HR, 1.87; 95% CI, 1.40–2.52) compared with serum sodium >136 mEq/L. A meta‐analysis done by the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) showed that hyponatremia (serum sodium <135 mEq/L) at baseline is associated with a 35% higher risk of mortality during 3 years of follow‐up among 3737 patients with HFpEF (HR, 1.35; 95% CI, 1.06–1.72), compared with serum sodium >135 mEq/L 16. On analyzing serum sodium as a continuous variable, the MAGGIC meta‐analysis found a linear increase in the risk of all‐cause mortality at 3 years at concentrations <140 mEq/L, which plateau at concentrations ≥140 mEq/L 16.…”

Section: Discussionmentioning

confidence: 99%

“…A meta‐analysis done by the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) showed that hyponatremia (serum sodium <135 mEq/L) at baseline is associated with a 35% higher risk of mortality during 3 years of follow‐up among 3737 patients with HFpEF (HR, 1.35; 95% CI, 1.06–1.72), compared with serum sodium >135 mEq/L 16. On analyzing serum sodium as a continuous variable, the MAGGIC meta‐analysis found a linear increase in the risk of all‐cause mortality at 3 years at concentrations <140 mEq/L, which plateau at concentrations ≥140 mEq/L 16. These studies examined the end point of all‐cause mortality alone and included patients with a known history of HF; hence, the relation of serum sodium to time after diagnosis of HF was variable.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies on the relation between hyponatremia and long‐term clinical outcomes in HFpEF patients have yielded inconsistent results 13, 14, 15, 16. To our knowledge, previous studies have not addressed whether values of serum sodium >135 mmol/L are associated with adverse clinical outcomes in HFpEF patients in a large cohort.…”

mentioning

confidence: 98%

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Prognostic Significance of Baseline Serum Sodium in Heart Failure With Preserved Ejection Fraction

Patel

Kurgansky

Imran

et al. 2018

JAHA

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BackgroundThe purpose of this study was to evaluate the relationship between serum sodium at the time of diagnosis and long term clinical outcomes in a large national cohort of patients with heart failure with preserved ejection fraction.Methods and ResultsWe studied 25 440 patients with heart failure with preserved ejection fraction treated at Veterans Affairs medical centers across the United States between 2002 and 2012. Serum sodium at the time of heart failure diagnosis was analyzed as a continuous variable and in categories as follows: low (115.00–134.99 mmol/L), low‐normal (135.00–137.99 mmol/L), referent group (138.00–140.99 mmol/L), high normal (141.00–143.99 mmol/L), and high (144.00–160.00 mmol/L). Multivariable Cox regression and negative binomial regression were performed to estimate hazard ratios (95% confidence interval [CI]) and incidence density ratios (95% CI) for the associations of serum sodium with mortality and hospitalizations (heart failure and all‐cause), respectively. The average age of patients was 70.8 years, 96.2% were male, and 14% were black. Compared with the referent group, low, low‐normal, and high sodium values were associated with 36% (95% CI, 28%–44%), 6% (95% CI, 1%–12%), and 9% (95% CI, 1%–17%) higher risk of all‐cause mortality, respectively. Low and low‐normal serum sodium were associated with 48% (95% CI, 10%–100%) and 38% (95% CI, 8%–77%) higher risk of number of days of heart failure hospitalizations per year, and with 44% (95% CI, 32%–56%) and 18% (95% CI, 10%–27%) higher risk of number of days of all‐cause hospitalizations per year, respectively.ConclusionsBoth elevated and reduced serum sodium, including values currently considered within normal range, are associated with adverse outcomes in patients with heart failure with preserved ejection fraction.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

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Prognostic Significance of Baseline Serum Sodium in Heart Failure With Preserved Ejection Fraction

Patel

Kurgansky

Imran

et al. 2018

JAHA

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A 3D Printed Wearable Bioelectronic Patch for Multi‐Sensing and In Situ Sweat Electrolyte Monitoring

Kim

Qian

Hoang

et al. 2021

Adv Materials Technologies

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Wearable biosensors′ ability to measure continuous health parameters gives promise to healthcare with great potentials to advance precision medicine. The stability and balance within the human body are critical for organ systems′ normal functions. The imbalance of electrolytes may lead to several diseases such as hypertension, heart failure, and kidney diseases. Sweat electrolytes analysis, that is, the analysis of one of the noninvasively accessible biofluids, can provide important information about physiologically relevant quantities, and a combination of them can be employed for comprehensive studies. However, wearable biosensors′ large‐scale utilization for extensive population monitoring requires rapid, reliable, low‐cost, and high‐throughput integration of such platforms. Here, 3D‐printing technology is adapted to develop a novel, multiplex, low‐cost, and mechanically flexible all‐inclusive integrated wearable (AIIW) patch, which contains 3D‐printed flexible sensors along with flexible wearable‐microfluidic sample handling (WMFSH) units, integrated in a few hours. The AIIW patch is fully characterized, and its utility for noninvasive and continuous health monitoring is successfully demonstrated by simultaneous ex situ and in situ measuring of multiple electrolyte levels in sweat. This work is envisioned as another step toward enabling personalized health monitoring practices by implementing 3D‐printing technology in the easy and low‐cost development of customized integrated, flexible wearable biosensing platforms to monitor an individual's health parameters.

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Association between serum sodium level trajectories and survival in patients with heart failure

Xia

Wang

et al. 2022

ESC Heart Failure

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Aims The effect of changes in serum sodium levels on the survival of patients with heart failure (HF) is unclear. We aimed to analyse the impact of serum sodium level trajectories on survival in intensive care unit (ICU) patients with HF. Methods A total of 4760 patients diagnosed with HF between 2001 and 2012 from the Medical Information Mart for Intensive Care III (MIMIC‐III) database were extracted. Of these patients, 1132 patients who died within 48 h of ICU admission were excluded, and 3628 patients were included in this retrospective cohort study. Sodium levels were measured at baseline, 6, 12, 18, 24, 30, 36, 42, and 48 h. Patients were divided into hyponatremia, normal, and hypernatremia groups based on baseline sodium levels, and trajectory modelling was performed for each group separately. Group‐based trajectory model (GBTM) method was utilized to identify serum sodium levels trajectories. Results The number of patients with hyponatremia (<135 mmol/L), normal sodium levels (135–145 mmol/L), and hypernatremia (>145 mmol/L) at baseline were 594 (16.37%), 2,738 (75.47%), and 296 (8.16%), respectively. A total of seven trajectory groups were identified, including hyponatremia‐slow rise group [initial levels (IL), 128.48 ± 5.42 mmol/L; end levels (EL), 131.23 ± 3.83 mmol/L], hyponatremia‐rapid rise to normal group (IL, 132.13 ± 2.18 mmol/L; EL, 137.46 ± 3.68 mmol/L), normal‐slow decline group (IL, 137.65 ± 2.15 mmol/L; EL, 134.50 ± 2.54 mmol/L), normal‐steady‐state group (IL, 139.20 ± 2.26 mmol/L; EL, 139.04 ± 2.58 mmol/L), normal‐slow rise group (IL, 140.94 ± 2.37 mmol/L; EL, 143.43 ± 2.89 mmol/L), hypernatremia‐rapid decline to normal group (IL, 146.31 ± 1.98 mmol/L; EL, 140.71 ± 3.61 mmol/L), and hypernatremia‐slow decline group (IL, 148.89 ± 5.54 mmol/L; EL, 146.28 ± 3.90 mmol/L). The results showed that hyponatremia‐slow rise group [hazard ratio (HR) = 1.35; 95% confidence interval (CI), 1.01–1.80, P = 0.040], hyponatremia‐rapid rise to normal group (HR = 1.37; 95% CI, 1.11–1.71, P = 0.004), hypernatremia‐rapid decline to normal group (HR = 1.46; 95% CI, 1.08–1.97, P = 0.014), and hypernatremia‐slow decline group (HR = 1.49; 95% CI, 1.07–2.07, P = 0.018) trajectories were associated with an increased risk of 1‐year mortality in HF patients compared with normal‐steady‐state group. After adjustment for all confounders, hyponatremia‐rapid rise to normal group (HR = 1.26, 95% CI; 1.01–1.57, P = 0.038) and hypernatremia‐rapid decline to normal group (HR = 1.36; 95% CI, 1.01–1.84, P = 0.047) trajectories were still related to an increased risk of 1‐year mortality in patients with HF. Conclusions Serum sodium level trajectories were associated with mortality in patients with HF. Association between serum sodium level trajectorie...

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Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure patients with preserved and with reduced ejection fraction: an individual patient data meta‐analysis†

Cited by 109 publications

References 31 publications

Prognostic Significance of Baseline Serum Sodium in Heart Failure With Preserved Ejection Fraction

Prognostic Significance of Baseline Serum Sodium in Heart Failure With Preserved Ejection Fraction

A 3D Printed Wearable Bioelectronic Patch for Multi‐Sensing and In Situ Sweat Electrolyte Monitoring

Association between serum sodium level trajectories and survival in patients with heart failure

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