Dehydration and serum hyperosmolarity as new predictors of mortality after acute coronary syndrome

Figuero, S Briongos; Jiménez-Mena, Manuel; Marcos, Javier Ortega; López, Ana M.; Santos, Sara Fernández; Segura, T; Cortés, Marcelino; Fernández, Marcelo Sanmartín; Gómez, José Luis Zamorano

doi:10.1016/j.ijcard.2014.01.033

Cited by 11 publications

(7 citation statements)

References 12 publications

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“…Several studies have reported that the measurement of plasma osmolality is an important evaluation and directive laboratory tool, especially in critically ill‐patients . Previously, a few studies have investigated the association of plasma osmolality with the in‐hospital mortality in patients with acute coronary syndrome . These studies reported that elevated levels of plasma osmolality are independently associated with increased in‐hospital mortality following acute coronary syndrome.…”

Section: Introductionmentioning

confidence: 99%

The predictive value of plasma osmolality for in‐hospital mortality in patients with acute pulmonary embolism

Öztaş¹,

Çınar²,

Hayıroğlu³

et al. 2019

Clinical Respiratory J

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Introduction and Objectives Prior studies demonstrated that plasma osmolality may have a predictive value for in‐hospital mortality in patients with heart failure and acute coronary syndrome. In addition, plasma glucose and blood urea nitrogen (BUN) levels, the components of plasma osmolality, have been shown to be an important contributor for in‐hospital mortality in acute pulmonary embolism (APE) patients. Hence, the objective of the current study is to evaluate the effect of plasma osmolality upon admission with in‐hospital mortality in patients with APE. Methods A total of 245 consecutive intermediate or high risk APE patients were enrolled into the study. The study population was divided into three tertile groups (T1, T2 and T3) based on the increased plasma osmolality. The in‐hospital mortality was the primary end‐point. Results After adjusting for all risk factors, in‐hospital mortality was significantly higher in the T3 group compared to T1 and T2 groups (OR: 3.6, 95% CI: 1.3 to 18.8, P < .001). In addition, the incidence of asystolia, hypotension and cardiogenic shock were significantly higher in the T3 group. An area under the receiver operating characteristic curve value of plasma osmolality for the in‐hospital mortality was 0.76 with sensitivity 67.2% and specificity 74.1% 95% CI: (0.66‐0.87, P < .001). Conclusion This is the first study to demonstrate that elevated levels of plasma osmolality may have a predictive value for in‐hospital mortality in APE patients. Our findings are novel and deserve further studies whether the treatment of higher plasma osmolality may reduce the risk of in‐hospital mortality in APE patients.

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Section: Introductionmentioning

confidence: 99%

The predictive value of plasma osmolality for in‐hospital mortality in patients with acute pulmonary embolism

Öztaş¹,

Çınar²,

Hayıroğlu³

et al. 2019

Clinical Respiratory J

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“…Recent data suggest that dehydration could be a trigger for AMI17 and a predictor of death post‐AMI 18. There are no studies evaluating hydration status in AMI patients with RAS, both entities being characterized by a complexity of neurohumoral responses.…”

Section: Introductionmentioning

confidence: 99%

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

Burlacu¹,

Siriopol

Voroneanu

et al. 2015

JAHA

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BackgroundWe are the first to evaluate the prevalence of renal artery stenosis (RAS) in consecutive patients with acute myocardial infarction (AMI) referred for primary percutaneous coronary intervention from a single tertiary center. As a novelty, we assessed hydration and metabolic status and measured arterial stiffness. We elaborated a predicting model for RAS in AMI.Methods and ResultsOne hundred and eighty‐one patients with AMI underwent concomitantly primary percutaneous coronary intervention and renal angiography. We obtained data on demographics, medical history, cardiovascular risk factors, echocardiography, Killip class, and blood tests. In the first 24 hours post–primary percutaneous coronary intervention, we assessed bioimpedance through Body Composition Monitoring® and arterial stiffness through pulsed‐wave velocity, SphygmoCor®. Significant RAS (>50% lumen narrowing, RAS+) was present in 16.6% patients. In the RAS+ group we recorded significantly higher stiffness, CRUSADE score and dehydration, and more women with higher prevalence of multivascular coronary artery disease and heart failure. In our multivariate models, variables independently associated with RAS+ were previous percutaneous coronary intervention, low estimated glomerular filtration rate, multivascular coronary artery disease, and total/extracellular body water. These models had good specificity and low sensitivity.ConclusionsWe observed that RAS+ AMI patients have a particular hydration, metabolic, and endothelial profile that could generate more future major adverse cardiac events. Hence, renal angiography in AMI should be considered in specific subsets of patients.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02388139.

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“…Several authors have suggested that TBI-related cardiac dysfunction is common and the consequence of the dysregulation of the central autonomic system [24,25]. However, an increase in plasma osmolality alone can also lead to cardiac dysfunction and increase mortality rate [14,16]. Therefore, we hypothesized that increase in plasma osmolality alone, following hyperosmotic treatment with mannitol, might also be an independent risk factor for cardiac arrhythmias in patients with TBI.…”

Section: Introductionmentioning

confidence: 96%

“…An increase in plasma osmolality as well as osmolal gap may lead to organ damage. For example, hyperosmolality can cause acute kidney injury (AKI) [11,12], and also impair cardiac function, increasing mortality in patients with heart failure [13][14][15]. In fact, hyperosmotic stress promotes cardiomyocyte injury [16], and an increase in plasma osmolality following hyperosmolar contrast administration can cause significant disorders in cardiac repolarisation reflected in electrocardiographic measurement [17,18].…”

Section: Introductionmentioning

confidence: 99%

Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients

Dąbrowski

Siwicka-Gieroba

Robba

et al. 2020

JCM

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Introduction: Hyperosmotic therapy with mannitol is frequently used for treatment cerebral edema, and 320 mOsm/kg H2O has been recommended as a high limit for therapeutic plasma osmolality. However, plasma hyperosmolality may impair cardiac function, increasing the risk of cardiac events. The aim of this study was to analyze the relation between changes in plasma osmolality and electrocardiographic variables and cardiac arrhythmia in patients treated for isolated traumatic brain injury (iTBI). Methods: Adult iTBI patients requiring mannitol infusion following cerebral edema, and with a Glasgow Coma Score below 8, were included. Plasma osmolality was measured with Osmometr 800 CLG. Spatial QRS-T angle (spQRS-T), corrected QT interval (QTc) and STJ segment were calculated from digital resting 12-lead ECGs and analyzed in relation to four levels of plasma osmolality: (A) <280 mOsm/kg H2O; (B) 280–295 mOsm/kg H2O; (C) 295–310 mOsm/kg H2O; and (D) >310 mOsm/kg H2O. All parameters were measured during five consecutive days of treatment. Results: 94 patients aged 18-64 were studied. Increased plasma osmolality correlated with prolonged QTc (p < 0.001), intensified disorders in STJ and increased the risk for cardiac arrhythmia. Moreover, plasma osmolality >313 mOms/kg H2O significantly increased the risk of QTc prolongation >500 ms. Conclusion: In patients treated for iTBI, excessively increased plasma osmolality contributes to electrocardiographic disorders including prolonged QTc, while also correlating with increased risk for cardiac arrhythmias.

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Dehydration and serum hyperosmolarity as new predictors of mortality after acute coronary syndrome

Cited by 11 publications

References 12 publications

The predictive value of plasma osmolality for in‐hospital mortality in patients with acute pulmonary embolism

The predictive value of plasma osmolality for in‐hospital mortality in patients with acute pulmonary embolism

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients

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