Hyponatremia as predictor of worse outcome in real world patients admitted with acute heart failure

Abstract

Background: Our aim was to determine if hyponatremia, defined as serum sodium level < 135 mmol/L, is a predictor of worse outcome in a cohort of real-world patients with heart failure (HF (OR 1.08, p < 0.01). Also mortality and readmissions were more frequent in patients with hyponatremia (20.69% and 22.41%, respectively) but after Cox regression adjustment hyponatremia in our cohort was not associated with increase in 90-day all-cause mortality and readmissions, and only CCI remained significant for primary end-point (HR 1.08, p < 0.001). Conclusions: Hyponatremia is an independent predictor of complications during hospitalization in our real-world cohort, but was not associated with 90 days mortality or readmissions. Global comorbidity, however, played an important role, and could influence the mortality and readmissions of our patients. (Cardiol J 2013; 20, 5: 506-512)

Hyponatremia in hospitalised patients with heart failure in internal medicine: Analysis of the Spanish national minimum basic data set (MBDS) (2005–2011)

“…In other words, the number of hyponatremia cases observed was smaller than expected when looking at the numbers reported in other studies; using an identical methodology, we reported this same 2.2% number of cases in a previous work [21]. Markedly higher figures are recorded in the RICA registry of acute heart failure from the Spanish Society of Internal Medicine (17%), and in other globally recognised international registries such as ADHERE (5%) [18,22]. However, despite the low prevalence of hyponatremia codification observed, it must be emphasised that the inclusion of hyponatremia diagnosis in the MBDS has been of great prognostic importance in terms of intrahospital mortality.…”

“…Predictive models of mortality in heart failure, like the Heart Failure Survival Score (HFSS) [15], the EFFECT model [16] and the Seattle Heart Failure Model [17], include hyponatremia values as one of the variables used to assess patient survival with HF. In Spain, Arévalo Lorido et al concluded that patients admitted to internal medicine for heart failure with sodium levels below 135 mmol/l are at greater risk of mortality and readmission during the phase of decompensated heart failure (OR 1.13) [18]. Our study shows for the first time that the inclusion of hyponatremia codified as ICD-9 diagnostic criteria during hospitalisation for HF is associated to an increased risk of intrahospital mortality (OR 1.57).…”

“…This limitation makes it difficult to compare the results obtained with other HF registries. Regarding the type of hyponatremia, we have not been able to obtain variables associated with patients' degree of congestion (dilutional hyponatremia), NYHA functional classes, natriuretic peptide levels or hyponatremia treatment variables (particularly diuretics) [26,18]. The study design also did not allow us to differentiate between patients with HF who acquired hyponatremia during their hospital stay and those who already had chronic hyponatremia before the onset of decompensated heart failure.…”

Hyponatremia in Acute Heart Failure in Relation to Hematocrit Levels: Clinical Relevance and Prognostic Implication

“…Its prevalence in AHF ranges from 15 to 25% [17][18][19]. Different studies have evaluated the rela- tionship between lower serum sodium levels and prognosis in AHF.…”

Hyponatremia and poor cognitive outcome following pediatric brain tumor surgery

“…However, hyponatremia has been associated with worsened morbidity and mortality in a variety of adult and pediatric populations. Among adult patients, hyponatremia is associated with increased mortality in adult surgical intensive care patients, 24 increased complications among patients with heart failure, 3 and worse Glasgow Outcome Scale score following subarachnoid hemorrhage 25 and traumatic brain injury. 20 Among pediatric populations, hyponatremia is associated with increased mortality among liver transplant patients 5 and in children with pneumococcal meningitis.…”