Recovery from hyponatremia in acute phase is associated with better in-hospital mortality rate in acute heart failure syndrome

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• 作者：Kenji Yoshioka ; MD^a ; Yuya Matsue ; MD ; PhD^a ; ^{yuya8950@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Nobuyuki Kagiyama ; MD^b ; Kazuki Yoshida ; MD ; MPH^c ; Teruyoshi Kume ; MD ; PhD ; FJCC^d ; Hiroyuki Okura ; MD ; PhD ; FJCC^e ; Makoto Suzuki ; MD ; PhD ; FJCC^a ; Akihiko Matsumura ; MD^a ; Kiyoshi Yoshida ; MD ; PhD ; FJCC^b ; Yuji Hashimoto ; MD ; PhD ; FJCC^a
• 关键词：Acute heart failure ; Hyponatremia ; Prognosis
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：67
• 期：5
• 页码：406-411
• 全文大小：445 K

文摘

Although hyponatremia on admission is a predictor of poor prognosis in acute heart failure (AHF) patients, little is known about the association between changes in sodium level in acute phase and in-hospital mortality. This study was performed to clarify the impact of sodium level improvement in the early phase on prognosis in AHF patients.

Methods

A total of 882 consecutive hospitalized AHF patients were retrospectively enrolled in this study. Sodium levels were evaluated on days 1 and 3 of admission, and patients were classified into three groups: patients with hyponatremia on admission and day 3 (hypo-hypo group); patients with hyponatremia on admission and normonatremia on day 3 (hypo-normo group); and patients with normonatremia on admission (normo group).

Results

Hyponatremia (sodium ≤135 mEq/L) was observed in 14.3% of cases. In multivariate linear regression analysis, age (standardized beta = 0.084), male gender (standardized beta = −0.072), history of ischemic heart disease (standardized beta = −0.069), baseline sodium level (standardized beta = −0.435), and tolvaptan use (standardized beta = 0.093) were independent determinants of changes in sodium level from day 1 to day 3. In-hospital mortality rates were significantly higher in the hypo-hypo group (23.7%) and hypo-normo group (9.7%) than the normo group (6.9%) (p < 0.001). After adjustment for covariates, both hypo-normo (OR: 0.28, 95% CI: 0.08–0.93, p = 0.038) and normo (OR: 0.42, 95% CI: 0.20–0.88, p = 0.022) groups showed significantly lower in-hospital mortality rates than the hypo-hypo group.

Conclusion

Early recovery from hyponatremia in AHF patients is associated with lower in-hospital mortality rate.