The Prognostic Role of Spot Urinary Sodium and Chloride in a Cohort of Hospitalized Advanced Heart Failure Patients: A Pilot Study

Abstract

Recent studies have demonstrated the prognostic value of spot urinary sodium (UNa+) in acutely decompensated chronic HF (ADCHF) patients. However, data on the prognostic role of UNa+ and spot urinary chloride (UCl−) in patients with advanced HF are limited. In the present prospective pilot study, we examined the predictive value of UNa+ and UCl− concentration at baseline, at 2 h and at 24 h after admission for all-cause mortality and HF rehospitalization up to 3 months post-discharge. Consecutive advanced HF patients (n = 30) admitted with ADCHF and aged > 18 years were included in the study. Loop diuretics were administered based on the natriuresis-guided algorithm recommended by the recent HF guidelines. Exclusion criteria were cardiogenic shock, acute coronary syndrome, estimated glomerular filtration rate < 15 mL/min/1.73 m2, severe hepatic dysfunction (Child–Pugh category C), and sepsis. UNa+ at baseline (Area Under the Curve (AUC) = 0.75, 95% Confidence Interval (CI) (0.58–0.93), p = 0.019) and at 2 h after admission (AUC = 0.80, 95% CI: 0.64–0.96, p = 0.005) showed good and excellent discrimination, respectively. UCl− at 2 h after admission (AUC = 0.75, 95%CI (0.57–0.93), p = 0.017) demonstrated good discrimination. In the multivariate logistic regression analysis, UNa+ at 2 h (p = 0.02) and dose of loop diuretics at admission (p = 0.03) were the only factors independently associated with the study outcome. In conclusion, UNa+ and UCl− may have a prognostic role in hospitalized advanced HF patients.

The role of urine chloride in acute heart failure

“…While uNa + has received substantial attention as an indicator of resistance to diuretic treatment and worsening HF symptoms leading to increased mortality 28 – 30 , uCl − has been overlooked as a valuable biomarker, despite its significant role in HF pathophysiology 31 . Most previous studies regarding Cl − have primarily focused on serum concentration 7 , and to the best of our knowledge, our study is among the few to explore the relationship between uCl − and patient outcomes 32 , 33 . Our analysis of urine biomarkers reveals a positive correlation between all analyzed electrolytes, consistent with trends observed in serum levels.…”

Analysis of the Larissa Heart Failure Risk Score: Predictive Value in 9207 Patients Hospitalized for Heart Failure from a Single Center

“…Long-term outcomes (1 year post-discharge) may be clinically important, especially with respect to identifying advanced HF patients that are potential candidates for left ventricular assist devices (LVAD) and/or heart transplantation. Furthermore, the combination of the LHFRS with novel markers of prognosis in HF, such as spot urinary sodium, may be a fruitful area of research [42].…”