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Gilloteaux J, De Swert K, Suain V, Nicaise C. Thalamic Neuron Resilience during Osmotic Demyelination Syndrome (ODS) Is Revealed by Primary Cilium Outgrowth and ADP-ribosylation factor-like protein 13B Labeling in Axon Initial Segment. Int J Mol Sci 2023; 24:16448. [PMID: 38003639 PMCID: PMC10671465 DOI: 10.3390/ijms242216448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
A murine osmotic demyelinating syndrome (ODS) model was developed through chronic hyponatremia, induced by desmopressin subcutaneous implants, followed by precipitous sodium restoration. The thalamic ventral posterolateral (VPL) and ventral posteromedial (VPM) relay nuclei were the most demyelinated regions where neuroglial damage could be evidenced without immune response. This report showed that following chronic hyponatremia, 12 h and 48 h time lapses after rebalancing osmolarity, amid the ODS-degraded outskirts, some resilient neuronal cell bodies built up primary cilium and axon hillock regions that extended into axon initial segments (AIS) where ADP-ribosylation factor-like protein 13B (ARL13B)-immunolabeled rod-like shape content was revealed. These AIS-labeled shaft lengths appeared proportional with the distance of neuronal cell bodies away from the ODS damaged epicenter and time lapses after correction of hyponatremia. Fine structure examination verified these neuron abundant transcriptions and translation regions marked by the ARL13B labeling associated with cell neurotubules and their complex cytoskeletal macromolecular architecture. This necessitated energetic transport to organize and restore those AIS away from the damaged ODS core demyelinated zone in the murine model. These labeled structures could substantiate how thalamic neuron resilience occurred as possible steps of a healing course out of ODS.
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Affiliation(s)
- Jacques Gilloteaux
- URPhyM, NARILIS, Université de Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium; (J.G.); (K.D.S.)
- Department of Anatomical Sciences, St George’s University School of Medicine, Newcastle upon Tyne NE1 JG8, UK
| | - Kathleen De Swert
- URPhyM, NARILIS, Université de Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium; (J.G.); (K.D.S.)
| | - Valérie Suain
- Laboratoire d’Histologie Générale, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Bruxelles, Belgium;
| | - Charles Nicaise
- URPhyM, NARILIS, Université de Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium; (J.G.); (K.D.S.)
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2
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Yang J, Zhang L, Guo M, Hao M. Effects of recombinant human brain natriuretic peptide combined with tolvaptan on cardiac and renal function and serum inflammatory factors in patients with severe heart failure. Medicine (Baltimore) 2023; 102:e35900. [PMID: 37960770 PMCID: PMC10637481 DOI: 10.1097/md.0000000000035900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
This study examined the effects of recombinant human brain natriuretic peptide (rhBNP) combined with tolvaptan on cardiac and renal function and serum inflammatory factors in patients with severe heart failure (HF). This retrospective study included 90 patients with severe HF who were treated at our hospital between January 2019 and August 2021. Patients treated with tolvaptan tablets were assigned to the control group, and those treated with rhBNP combined with tolvaptan were assigned to the observation group. Efficacy, cardiac function, levels of inflammatory factors, renal function, 6 minutes walking test, Minnesota Living with Heart Failure Questionnaire score, and adverse reactions were assessed. The curative effect (97.78% vs 77.78%) and improvement in cardiac function were greater in the observation group than in the control group (P < .05). Decreased levels of inflammatory factors were seen in both groups after treatment, and the levels of tumor necrosis factor-α, interleukin-33, and intercellular adhesion factor-1 in the observation group were lower than those in the control group (P < .05). The 6 minutes walking test was higher and the Minnesota Living with Heart Failure Questionnaire score was lower in the observation group compared with the control group (P < .05). The incidence of adverse reactions such as dry mouth, nausea, polyuria, hypotension, and headache in the observation group was lower than that in the control group (P < .05). In conclusion, for patients with severe HF, rhBNP combined with tolvaptan can improve cardiac function, alleviate symptoms of dyspnea, protect renal function, and reduce serum inflammatory factor levels when compared with tolvaptan alone.
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Affiliation(s)
- Jing Yang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Sarastri Y, Zebua JI, Lubis PN, Zahra F, Lubis AC. Admission hyponatraemia as heart failure events predictor in patients with acute heart failure. ESC Heart Fail 2023; 10:2966-2972. [PMID: 37519045 PMCID: PMC10567628 DOI: 10.1002/ehf2.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 04/17/2023] [Accepted: 07/02/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS Heart failure remained consistent as one of the biggest cardiovascular problems in Indonesia. Hyponatraemia is a common electrolyte disorder among patients presented with heart failure; however, the prognostic value for worsening heart failure has not been well defined. METHODS AND RESULTS We studied 134 patients admitted with acute heart failure and investigated the relationship between admission serum sodium and the composite clinical outcomes of all-cause mortality and hospitalization ambispectively with a follow-up duration of 6 months. We also try to look for low sodium-level impacts in several conditions. Among 134 patients, 84 patients presented with low sodium during admission, defined as a serum sodium level of <135 mEq/L, and it was associated with higher composite clinical outcome risk [odds ratio (OR), 5.9; 95% confidence interval (CI), 2.8-12.0; P < 0.001]. Moreover, hyponatraemia impacts on composite endpoints were driven by both parameters; it was independently associated with mortality (OR, 3.1; 95% CI, 1.4-6.8; P = 0.003) and rehospitalization (OR, 5.3; 95% CI, 2.4-11.7; P < 0.001). This result remained consistent in most subgroups. CONCLUSIONS On-admission hyponatraemia is a predictor for 6 month mortality and rehospitalization. Further work is needed to determine if correction of hyponatraemia translates into clinical benefit.
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Affiliation(s)
- Yuke Sarastri
- Faculty of MedicineUniversitas Sumatera UtaraMedanIndonesia
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
| | - Juang Idaman Zebua
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
| | - Puja Nastia Lubis
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
| | - Fathi Zahra
- Faculty of MedicineUniversitas TrisaktiWest JakartaIndonesia
| | - Anggia Chairuddin Lubis
- Faculty of MedicineUniversitas Sumatera UtaraMedanIndonesia
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
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Chu CH, Chien WC, Liu CC, Chung CH, Chen YC, Kuo FC, Fang HH, Cheng CY, Ding YX, Tien CH, Lin CM. An enigma of hypothyroidism and hyponatremia coexistence: a nationwide population-based retrospective study. BMC Public Health 2023; 23:1889. [PMID: 37775735 PMCID: PMC10541708 DOI: 10.1186/s12889-023-16791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Hypothyroidism is a rare and possible cause of hyponatremia. However, the clinical epidemiology and risk of mortality (ROM) when they coexist still remain elusive. OBJECTIVES We assessed the epidemiology and ROM among index patients with coexisting hypothyroidism and hyponatremia via a national population database. PATIENTS AND METHODS This retrospective cohort study utilized Taiwan's National Health Insurance program database. Distributions of definite sociodemographic factors were analyzed. The annual incidence among the overall group and sex-subgroups was investigated. In addition, potential factors influencing the ROM were also evaluated. RESULTS Of 4,549,226 patients from 1998 to 2015, a total of 3,140 index patients with concurrent hypothyroidism and hyponatremia were analyzed. The incidence rate increased tenfold from 1998 to 2015; average annual incidence rate was 174. Among the total participants, 57.1% were women; mean age was 72.6 ± 14.7 years and 88.8% were aged > 55 years. Although average length of stay (LOS) was 13.1 ± 15.4 days, the mortality group had significantly longer LOS than that in the survival group (12.9 days vs 22.2 days). Old age, catastrophic illness, cardiac dysrhythmia, and low hospital hierarchy were independent predictors of hospital mortality. The optimal LOS cutoff value for ROM prediction was 16 days. Index patients with LOS > 16 days increased ROM by 2.3-fold. CONCLUSIONS Coexistent hypothyroidism and hyponatremia is rare, although the incidence increased gradually. Factors influencing the ROM, such as old age, underlying catastrophic status, cardiac dysrhythmia, hospital hierarchy, and LOS should be considered in clinical care.
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Affiliation(s)
- Chun-Hao Chu
- Department of Pediatrics, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chiung-Chen Liu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Ying-Chuan Chen
- Department of Physiology & Biophysics, National Defense Medical Center, Taipei, Taiwan
| | - Feng-Chih Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Hsiang Fang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Yi Cheng
- PET Center and Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Xuan Ding
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chiung-Hsi Tien
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Ming Lin
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Aziz F, Sam R, Lew SQ, Massie L, Misra M, Roumelioti ME, Argyropoulos CP, Ing TS, Tzamaloukas AH. Pseudohyponatremia: Mechanism, Diagnosis, Clinical Associations and Management. J Clin Med 2023; 12:4076. [PMID: 37373769 DOI: 10.3390/jcm12124076] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Pseudohyponatremia remains a problem for clinical laboratories. In this study, we analyzed the mechanisms, diagnosis, clinical consequences, and conditions associated with pseudohyponatremia, and future developments for its elimination. The two methods involved assess the serum sodium concentration ([Na]S) using sodium ion-specific electrodes: (a) a direct ion-specific electrode (ISE), and (b) an indirect ISE. A direct ISE does not require dilution of a sample prior to its measurement, whereas an indirect ISE needs pre-measurement sample dilution. [Na]S measurements using an indirect ISE are influenced by abnormal concentrations of serum proteins or lipids. Pseudohyponatremia occurs when the [Na]S is measured with an indirect ISE and the serum solid content concentrations are elevated, resulting in reciprocal depressions in serum water and [Na]S values. Pseudonormonatremia or pseudohypernatremia are encountered in hypoproteinemic patients who have a decreased plasma solids content. Three mechanisms are responsible for pseudohyponatremia: (a) a reduction in the [Na]S due to lower serum water and sodium concentrations, the electrolyte exclusion effect; (b) an increase in the measured sample's water concentration post-dilution to a greater extent when compared to normal serum, lowering the [Na] in this sample; (c) when serum hyperviscosity reduces serum delivery to the device that apportions serum and diluent. Patients with pseudohyponatremia and a normal [Na]S do not develop water movement across cell membranes and clinical manifestations of hypotonic hyponatremia. Pseudohyponatremia does not require treatment to address the [Na]S, making any inadvertent correction treatment potentially detrimental.
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Affiliation(s)
- Fahad Aziz
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Ramin Sam
- Department of Medicine, Zuckerberg San Francisco General Hospital, School of Medicine, University of California in San Francisco, San Francisco, CA 94110, USA
| | - Susie Q Lew
- Department of Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC 20052, USA
| | - Larry Massie
- Department of Pathology, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87108, USA
| | - Madhukar Misra
- Department of Medicine, Division of Nephrology, University of Missouri, Columbia, MO 65211, USA
| | - Maria-Eleni Roumelioti
- Department of Medicine, Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA
| | - Christos P Argyropoulos
- Department of Medicine, Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA
| | - Todd S Ing
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Antonios H Tzamaloukas
- Research Service, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87108, USA
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Tang H, Xu C, Zhang P, Luo T, Huang Y, Yang X. A profile of SGLT-2 inhibitors in hyponatremia: The evidence to date. Eur J Pharm Sci 2023; 184:106415. [PMID: 36870579 DOI: 10.1016/j.ejps.2023.106415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Hyponatremia is the most common electrolyte disorder in clinical practice, which may lead to life-threatening complications. Several lines of evidence suggest that hyponatremia is associated not only with significant increases in length of stay, cost, and financial burden, but also with increased morbidity and mortality. Hyponatremia is also considered to be a negative prognostic factor in patients with heart failure and cancer. Although multiple therapeutic methods are available for treating hyponatremia, most have some limitations, such as poor compliance, rapid correction of serum Na+, other negative side effects and high cost. Given these limitations, identifying novel therapies for hyponatremia is essential. Recent clinical studies have shown that SGLT-2 inhibitors (SGLT 2i) significantly increased serum Na+ levels and were well tolerated by patients who underwent this treatment. Therefore, oral administration of SGLT 2i appears to be an effective treatment for hyponatremia. This article will briefly review the etiology of hyponatremia and integrated control of sodium within the kidney, current therapies for hyponatremia, potential mechanisms and efficacy of SGLT 2i for hyponatremia, and the benefits in cardiovascular, cancer, and kidney disease by regulating sodium and water balance.
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Affiliation(s)
- Hui Tang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China
| | - Changjing Xu
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Piao Zhang
- Department of Pharmacy, Ya 'an People's Hospital, Ya 'an, Sichuan 646000, China
| | - Taimin Luo
- Department of pharmacy, Chengdu Seventh People's Hospital, Chengdu, Sichuan 610000, China
| | - Yilan Huang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China.
| | - Xuping Yang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China.
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Workeneh BT, Meena P, Christ-Crain M, Rondon-Berrios H. Hyponatremia Demystified: Integrating Physiology to Shape Clinical Practice. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:85-101. [PMID: 36868737 PMCID: PMC9993811 DOI: 10.1053/j.akdh.2022.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/05/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
Hyponatremia is one of the most common problems encountered in clinical practice and one of the least-understood because accurate diagnosis and management require some familiarity with water homeostasis physiology, making the topic seemingly complex. The prevalence of hyponatremia depends on the nature of the population studied and the criteria used to define it. Hyponatremia is associated with poor outcomes including increased mortality and morbidity. The pathogenesis of hypotonic hyponatremia involves the accumulation of electrolyte-free water caused by either increased intake and/or decrease in kidney excretion. Plasma osmolality, urine osmolality, and urine sodium can help to differentiate among the different etiologies. Brain adaptation to plasma hypotonicity consisting of solute extrusion to mitigate further water influx into brain cells best explains the clinical manifestations of hyponatremia. Acute hyponatremia has an onset within 48 hours, commonly resulting in severe symptoms, while chronic hyponatremia develops over 48 hours and usually is pauci-symptomatic. However, the latter increases the risk of osmotic demyelination syndrome if hyponatremia is corrected rapidly; therefore, extreme caution must be exercised when correcting plasma sodium. Management strategies depend on the presence of symptoms and the cause of hyponatremia and are discussed in this review.
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Affiliation(s)
- Biruh T Workeneh
- Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priti Meena
- All India Institute of Medical Sciences, Bhubaneswar, India
| | - Mirjam Christ-Crain
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Helbert Rondon-Berrios
- Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Xiao M, Wang X, Wang H, Du F, Yao Y, Wang X, Wang J, Yang J, Xiong W, Wang Q, Ren X, Zhu T. Risk factors for hyponatremia in acute exacerbation chronic obstructive pulmonary disease (AECOPD): a multicenter cross-sectional study. BMC Pulm Med 2023; 23:39. [PMID: 36709254 PMCID: PMC9884134 DOI: 10.1186/s12890-023-02328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Hyponatremia is an independent predictor of poor prognosis, including increased mortality and readmission, in COPD patients. Identifying modifiable etiologies of hyponatremia may help reduce adverse events in patients with AECOPD. Therefore, the aim of this study was to explore the risk factors and underlying etiologies of hyponatremia in AECOPD patients. METHODS A total of 586 AECOPD patients were enrolled in this multicenter cross-sectional study. Finally, 323 had normonatremia, and 90 had hyponatremia. Demographics, underlying diseases, comorbidities, symptoms, and laboratory data were collected. The least absolute shrinkage and selection operator (LASSO) regression was used to select potential risk factors, which were substituted into binary logistic regression to identify independent risk factors. Nomogram was built to visualize and validate binary logistics regression model. RESULTS Nine potential hyponatremia-associated variables were selected by LASSO regression. Subsequently, a binary logistic regression model identified that smoking status, rate of community-acquired pneumonia (CAP), anion gap (AG), erythrocyte sedimentation rate (ESR), and serum magnesium (Mg2+) were independent variables of hyponatremia in AECOPD patients. The AUC of ROC curve of nomogram was 0.756. The DCA curve revealed that the nomogram could yielded more clinical benefits if the threshold was between 10% and 52%. CONCLUSIONS Collectively, our results showed that smoking status, CAP, AG, ESR, and serum Mg2+ were independently associated with hyponatremia in AECOPD patients. Then, these findings indicate that pneumonia, metabolic acidosis, and hypomagnesemia were the underlying etiologies of hyponatremia in AECOPD patients. However, their internal connections need further exploration.
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Affiliation(s)
- Min Xiao
- grid.412901.f0000 0004 1770 1022Respiratory Medicine and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041 China
| | - Xiaoyu Wang
- grid.412901.f0000 0004 1770 1022Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, 610041 China
| | - Hanchao Wang
- Respiratory Medicine and Critical Care Medicine, and Preclinical Research Center, Suining Central Hospital, Suining, 629000 Sichuan China
| | - Fawang Du
- Respiratory Medicine and Critical Care Medicine, and Preclinical Research Center, Suining Central Hospital, Suining, 629000 Sichuan China
| | - Yu Yao
- Respiratory Medicine and Critical Care Medicine, and Preclinical Research Center, Suining Central Hospital, Suining, 629000 Sichuan China
| | - Xiaochuan Wang
- Respiratory Medicine and Critical Care Medicine, and Preclinical Research Center, Suining Central Hospital, Suining, 629000 Sichuan China
| | - Jiajia Wang
- grid.412461.40000 0004 9334 6536Rheumatology Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 China
| | - Juan Yang
- grid.66875.3a0000 0004 0459 167XDivision of General Internal Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - Wei Xiong
- grid.412461.40000 0004 9334 6536Respiratory Medicine and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 China
| | - Qin Wang
- grid.412461.40000 0004 9334 6536Respiratory Medicine and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 China
| | - Xubin Ren
- Respiratory Medicine and Critical Care Medicine, Chengdu First People’s Hospital, Chengdu, 610041 Sichuan China
| | - Tao Zhu
- Respiratory Medicine and Critical Care Medicine, and Preclinical Research Center, Suining Central Hospital, Suining, 629000 Sichuan China
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Rao J, Ma Y, Long J, Tu Y, Guo Z. The combined impact of hyponatremia and hematocrit on the risk for 90-day readmission and death in patients with heart failure: dilutional hyponatremia versus depletional hyponatremia. Ann Saudi Med 2023; 43:17-24. [PMID: 36739500 PMCID: PMC9899337 DOI: 10.5144/0256-4947.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hyponatremia is common in hospitalized patients with heart failure (HF) and predicts a poor prognosis after discharge. In general, hyponatremia can be divided into two types: dilutional or depletional. OBJECTIVE Assess the impact of hyponatremia type on short-term outcomes. DESIGN Retrospective cohort SETTINGS: Single center in China PATIENTS AND METHODS: We sorted patients by hyponatremia into two types: dilutional hyponatremia (DiH, with hematocrit <35%) and depletional hyponatremia (DeH, with hematocrit ≥35%). The Kaplan-Meier method and Cox regression analysis were used to identify the impact of hyponatremia types on the risk for 90-day readmission and death. MAIN OUTCOME MEASURES 90-day readmission and death combined. SAMPLE SIZE 1770 patients. RESULTS Hyponatremia was present in 324/1770 patients with 182 cases classified as DiH versus 142 as DeH. Kaplan-Meier analyses showed a higher incidence of poor short-term outcomes in hyponatremia compared with normonatremia (log-rank P<.001), and the risk was higher in DiH than DeH although the difference was not statistically significant (log-rank P=.656). Multivariate Cox regression analyses showed that only DiH was independently associated with short-term outcomes (HR=1.34, 95%CI: 1.02-1.77, P=.038), but not DeH (HR=1.32, 95%CI: 0.97-1.80, P=.081). Analysis of the secondary endpoints showed that DiH increased the risk of readmission but not death (HR=1.36, P=.035 for readmission; HR=1.13, P=.831 for all-cause death). CONCLUSIONS Low hematocrit, rather than high hematocrit, with hyponatremia was associated with a risk of 90-day readmission in patients with HF. LIMITATIONS Single center, nonrandomized. CONFLICT OF INTEREST None.
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Affiliation(s)
- Jiahuan Rao
- From the Department of Cardiology, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yusheng Ma
- From the Department of Cardiology, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jieni Long
- From the Department of Cardiology, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Tu
- From the Department of Cardiology, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhigang Guo
- From the Department of Cardiology, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
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10
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Chen S, Wu P, Wang L, Wei C, Cheng C, Fang H, Fang Y, Chen Y, Huang DK, Lee F, Chen M. Optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure. ESC Heart Fail 2022; 10:895-906. [PMID: 36460605 PMCID: PMC10053263 DOI: 10.1002/ehf2.14240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/04/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022] Open
Abstract
AIMS The timely selection of severe heart failure (HF) patients for cardiac transplantation and advanced HF therapy is challenging. Peak oxygen consumption (VO2 ) values obtained by the cardiopulmonary exercise testing are used to determine the transplant recipient list. This study reassessed the prognostic predictability of peak VO2 and compared it with the Heart Failure Survival Score (HFSS) in the modern optimized guideline-directed medical therapy (GDMT) era. METHODS AND RESULTS We retrospectively selected 377 acute HF patients discharged from the hospital. The primary outcome was a composite of all-cause mortality, or urgent cardiac transplantation. We divided these patients into the more GDMT (two or more types of GDMT) and less GDMT groups (fewer than two types of GDMT) and compared the performance of their peak VO2 and HFSS in predicting primary outcomes. The median follow-up period was 3.3 years. The primary outcome occurred in 57 participants. Peak VO2 outperformed HFSS when predicting 1 year (0.81 vs. 0.61; P = 0.017) and 2 year (0.78 vs. 0.58; P < 0.001) major outcomes. The cutoff peak VO2 for predicting a 20% risk of a major outcome within 2 years was 10.2 (11.8-7.0) for the total cohort. Multivariate Cox regression analyses showed that peak VO2 , sodium, previous implantable cardioverter defibrillator (ICD) implantation, and estimated glomerular filtration rate were significant predictors of major outcomes. CONCLUSIONS Optimizing the cutoff value of peak VO2 is required in the current GDMT era for advanced HF therapy. Other clinical factors such as ICD use, hyponatraemia, and chronic kidney disease could also be used to predict poor prognosis. The improvement of resource allocation and patient outcomes could be achieved by careful selection of appropriate patients for advanced HF therapies, such as cardiac transplantation.
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Affiliation(s)
- Shyh‐Ming Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
- Chang Gung University College of Medicine Taoyuan City Taiwan, Republic of China
| | - Po‐Jui Wu
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
| | - Lin‐Yi Wang
- Department of Physical Medicine and Rehabilitation Kaohsiung Chang Gung Memorial Hospital Kaohsiung City Taiwan, Republic of China
| | - Chin‐Ling Wei
- Department of Nursing, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital Kaohsiung City Taiwan, Republic of China
| | - Cheng‐I Cheng
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
- Chang Gung University College of Medicine Taoyuan City Taiwan, Republic of China
| | - Hsiu‐Yu Fang
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
| | - Yen‐Nan Fang
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
| | - Yung‐Lung Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
- Chang Gung University College of Medicine Taoyuan City Taiwan, Republic of China
| | - David Kwan‐Ru Huang
- Division of Cardiovascular Surgery, Department of Surgery Kaohsiung Chang Gung Memorial Hospital Kaohsiung City Taiwan, Republic of China
| | - Fan‐Yen Lee
- Division of Cardiovascular Surgery, Department of Surgery Kaohsiung Chang Gung Memorial Hospital Kaohsiung City Taiwan, Republic of China
| | - Mien‐Cheng Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
- Chang Gung University College of Medicine Taoyuan City Taiwan, Republic of China
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11
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Peng S, Peng J, Yang L, Ke W. Relationship between serum sodium levels and all-cause mortality in congestive heart failure patients: A retrospective cohort study based on the Mimic-III database.. [DOI: 10.21203/rs.3.rs-1919991/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
BACKGROUND: The relationship between serum sodium levels and mortality in congestive heart failure (CHF) patients has not been well studied previously. Serum sodium levels are linked to an increased risk of all-cause death in CHF patients over the short, medium, and long term. Serum sodium levels are strongly linked to an increased risk of death from congestive heart failure and could be a new risk factor for cardiovascular disease. The goal of this study is to look into the relationship between serum sodium levels and all-cause mortality in people with CHF after controlling for other factors.METHODS: The publicly accessible Mimic III database was the source of data for our study. We use the ICU Admission Scoring System to collect demographic data, laboratory findings, comorbidities, vital signs, and scoring information for each patient. Cox proportional risk analysis, smooth curve fitting, and the Kaplan-Meier survival curve were used to assess the relationship between baseline sodium levels and all-cause mortality in CHF patients.RESULTS: The segmentation regression model discovered a turning point value of serum sodium levels (137.5mmol/L) between serum sodium levels and all-cause mortality. According to the results of the fully adjusted Cox proportional hazard model, lower serum sodium levels (<137.5mmol/L) were associated with an increased risk of 30-day, 90-day, 365-day, and 4-year all-cause deaths. The HRs and 95th confidence intervals were 0.96 (0.94, 0.99) , 0.96 (0.94, 0.99), 0.96 (0.94, 0.98) , and 0.96 (0.95, 0.98), respectively; The higher Serum sodium levels(≥137.5mmol/L) were related to associate multiplied risk of 30-day, 90-day, 365-day, and 4-year all-cause deaths; the HRs and 95th confidence intervals were 1.02 (1.00, 1.05), 1.02 (1.00, 1.04), 1.02 (1.00, 1.03) , and 1.02 (1.00, 1.03), respectively.CONCLUSION: Serum sodium levels were u-shaped about all-cause mortality. In individuals with CHF, serum sodium levels are linked to an elevated risk of short-, medium-, and long-term all-cause mortality.
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Affiliation(s)
- Shixuan Peng
- The First People's Hospital of Xiangtan City, the University of South China
| | | | | | - Weiqi Ke
- The First Affiliated Hospital of Shantou University Medical College
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12
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Zhao L, Zhao X, Tian P, Liang L, Huang B, Huang L, Feng J, Zhang Y, Zhang J. Prognostic utility of the prognostic nutritional index combined with serum sodium level in patients with heart failure. Nutr Metab Cardiovasc Dis 2022; 32:1894-1902. [PMID: 35637081 DOI: 10.1016/j.numecd.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Both malnutrition and hyponatremia (serum sodium <135 mmol/L) can be induced by the impaired absorption function of the edematous intestinal wall caused by heart failure (HF) and are prognostic factors of mortality in HF. However, little is known about the interrelationship of nutritional status and hyponatremia in mortality risk prediction in HF. METHODS AND RESULTS This study enrolled 2882 HF patients admitted to the HF care unit of Fuwai Hospital, Beijing, China from 2008 to 2018; 71.3% were male and the mean age was 56.64 ± 15.96 years. Nutritional status was assessed by prognostic nutritional index (PNI), calculated as serum albumin (g/L) + 5 × total lymphocyte count (109/L). Lower PNI indicates worse nutritional status. Patients were divided into 8 groups based on baseline PNI quartiles (Q1: <43.6, Q2: 43.6-48.55, Q3: 48.55-63.25, Q4: >63.25) and sodium level (normal sodium and hyponatremia). After adjustment, patients in the PNI Q1 associated with hyponatremia had a 2.12-fold higher risk of all-cause death (95% confidence interval [CI]: 1.67-2.70) compared with those in the PNI Q4 with normal sodium. A refinement in risk prediction was observed after adding PNI quartile and serum sodium category to the original model (ΔC-statistic = 0.018, 95% CI: 0.007-0.025; net re-classification index = 0.459, 95% CI: 0.371-0.548; integrated discrimination improvement = 0.025, 95% CI: 0.018-0.032). CONCLUSION HF patients with both the lowest PNI quartile and hyponatremia are at higher risk of all-cause mortality. The combination of PNI and serum sodium level enhanced the predictive value for all-cause mortality in hospitalized HF patients. CLINICAL TRIAL REGISTRATION URL: ClinicalTrials.gov; Unique Identifier: NCT02664818.
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Affiliation(s)
- Lang Zhao
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xuemei Zhao
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Pengchao Tian
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Lin Liang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Boping Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Liyan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jiayu Feng
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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13
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Relationships between sodium levels, haemodynamics and metalloproteinases in heart failure patients. Heart Vessels 2022; 37:986-993. [PMID: 35031882 DOI: 10.1007/s00380-021-02004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/03/2021] [Indexed: 11/04/2022]
Abstract
To estimate the associations between dysnatraemia and inflammatory marker [including interleukin-6 (IL-6)], and tissue remodelling marker [matrix metalloproteinase (MMP)-9 and tissue inhibitor of MMP (TIMP)-1], the pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure (PAP), and left ventricular end-diastolic pressure (EDP), and the prognostic relevance in patients with heart failure. The serum sodium level and circulating levels of IL-6, MMP-9, and TIMP-1 were measured in 173 heart failure patients. Dual heart catheterisation was performed to measure PCWP, mean PAP, and EDP. All-cause mortality was assessed during the follow-up period (mean 88 ± 49 months). Restricted cubic spline (RCS) regression showed a U-shaped association of serum sodium level with TIMP-1, with the lowest values in the 138-140 mmol/L range (P for effect = 0.042, P for non-linearity = 0.017). IL-6 and MMP-9 levels showed non-significant associations with serum sodium level. U-shaped associations of serum sodium level with PCWP (P for effect = 0.004, P for non-linearity = 0.001) and mean PAP (P for effect = 0.042, P for non-linearity = 0.017) were found with the RCS regression model. The random forest model revealed that TIMP-1, MMP-9, and IL-6 were important predictors for serum sodium levels. Restricted cubic spline Cox regressions demonstrated that TIMP-1 levels indicated a U-shaped, concaved, non-linear association with all-cause mortality (P for effect = 0.011, P for non-linearity = 0.022). Dysnatraemia is an index of TIMP-1 aggravation and elevated PCWP, mean PAP; hence, it is associated with worsening all-cause mortality.Clinical Trial Registration: UMIN000023840.
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14
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Takehisa Y, Yamato K, Arao T, Takehisa T. [Analysis of changes in location before hospital admission, discharge destination and prognostic factors for the survival in hospitals with chronic-phase inpatients]. Nihon Ronen Igakkai Zasshi 2022; 59:347-359. [PMID: 36070909 DOI: 10.3143/geriatrics.59.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM To clarify changes in location before hospital admission and discharge destination over the 10-year period of 2010 to 2020 and to identify prognostic factors associated with the survival in hospitals with chronic-phase inpatients. METHODS The subjects were patients newly admitted to 12 hospitals in 2010 and 2020. The age, sex, location before hospital admission, outcomes at 90 days after admission, discharge destination, and results of 6 biochemical tests at admission were evaluated. A survival analysis was performed for the age, sex, and biochemical tests at admission. RESULTS We analyzed 8007 newly hospitalized patients. Compared with 2010, there were more hospital admissions from acute-care hospitals and fewer admissions from long-term-care facilities in 2020. In addition, relative to 2010, regarding the outcomes at 90 days after admission, there were more discharges to home and residential facilities in 2020, fewer discharges to long-term-care facilities, and lower mortality rates. In the survival analysis, a multivariate analysis revealed that an elderly age, male sex, low albumin, high total cholesterol, high urea nitrogen, and low serum sodium were poor prognostic factors. These five variables were consistently poor prognostic factors in both 2010 and 2020, and Kaplan-Meier curves showed that the scores were dose-dependent prognostic factors for a poor survival. CONCLUSIONS The present analysis of pre-admission location and discharge destination in hospitals with chronic-phase patients revealed an elderly age, male sex, high urea nitrogen, low serum sodium, and low albumin at the time of admission to be strong predictors of poor outcomes in these patients.
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Affiliation(s)
- Yozo Takehisa
- Medical Foundation Heisei Hakuaikai Hakuai Memorial Hospital
| | - Kaoru Yamato
- Medical Foundation Heisei Hakuaikai Hakuai Memorial Hospital
| | - Tokuzo Arao
- General Incorporated Foundation Kishiwada Nouyuukyoukai Kishiwada Heisei Hospital
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15
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Peng S, Peng J, Yang L, Ke W. Relationship between serum sodium levels and all-cause mortality in congestive heart failure patients: A retrospective cohort study based on the Mimic-III database. Front Cardiovasc Med 2022; 9:1082845. [PMID: 36712264 PMCID: PMC9880197 DOI: 10.3389/fcvm.2022.1082845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The relationship between serum sodium levels and mortality in congestive heart failure (CHF) patients has not been well-studied previously. The non-linear correlation between serum sodium levels and mortality in patients with heart failure is currently controversial, and the relationship between different serum sodium levels and mortality is disputed. The goal of this study is to look into the relationship between serum sodium levels and all-cause mortality in people with CHF after controlling for other factors. METHODS The publicly accessible Mimic III database was the source of data for our study. We use the ICU Admission Scoring System to collect demographic data, laboratory findings, comorbidities, vital signs, and scoring information for each patient. Cox proportional risk analysis, smooth curve fitting, and the Kaplan-Meier survival curve were used to assess the relationship between baseline sodium levels and all-cause mortality in CHF patients. RESULTS The segmentation regression model discovered a turning point value of serum sodium levels (137.5 mmol/L) between serum sodium levels and all-cause mortality. According to the results of the fully adjusted Cox proportional hazard model, lower serum sodium levels (<137.5 mmol/L) were associated with an increased risk of 30, 90, 365-day, and 4-year all-cause deaths. The HRs and 95th confidence intervals were 0.96 (0.94, 0.99), 0.96 (0.94, 0.99), 0.96 (0.94, 0.98), and 0.96 (0.95, 0.98), respectively; the higher serum sodium levels (≥137.5 mmol/L) were related to an associated multiplied risk of 30, 90, 365-day, and 4-year all-cause deaths; the HRs and 95th confidence intervals were 1.02 (1.00, 1.05), 1.02 (1.00, 1.04), 1.02 (1.00, 1.03), and 1.02 (1.00, 1.03), respectively. CONCLUSION Serum sodium levels were u-shaped about all-cause mortality. In individuals with CHF, serum sodium levels are linked to an elevated risk of short-, medium-, and long-term all-cause mortality.
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Affiliation(s)
- Shixuan Peng
- Department of Oncology, Graduate Collaborative Training Base of The First People's Hospital of Xiangtan City, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jianxing Peng
- Department of Orthopaedics, Anxiang People's Hospital, Changde, Hunan, China
| | - Lianju Yang
- Department of Health Management Centre, Anxiang People's Hospital, Changde, Hunan, China
| | - Weiqi Ke
- Department of Anesthesiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- *Correspondence: Weiqi Ke ✉
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16
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Restoration of dysnatremia and acute kidney injury benefits outcomes of acute geriatric inpatients. Sci Rep 2021; 11:20097. [PMID: 34635719 PMCID: PMC8505420 DOI: 10.1038/s41598-021-99677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/24/2021] [Indexed: 11/08/2022] Open
Abstract
Dysnatremia and dyskalemia are common problems in acutely hospitalized elderly patients. These disorders are associated with an increased risk of mortality and functional complications that often occur concomitantly with acute kidney injury in addition to multiple comorbidities. In a single-center prospective observational study, we recruited 401 acute geriatric inpatients. In-hospital outcomes included all-cause mortality, length of stay, and changes in functional status as determined by the Activities of Daily Living (ADL) scale, Eastern Cooperative Oncology Group (ECOG) performance, and Clinical Frailty Scale (CFS). The prevalence of dysnatremia alone, dyskalemia alone, and dysnatremia plus dyskalemia during initial hospitalization were 28.4%, 14.7% and 32.4%, respectively. Patients with electrolyte imbalance exhibited higher mortality rates and longer hospital stays than those without electrolyte imbalance. Those with initial dysnatremia, or dysnatremia plus dyskalemia were associated with worse ADL scores, ECOG performance and CFS scores at discharge. Subgroup analyses showed that resolution of dysnatremia was related to reduced mortality risk and improved CFS score, whereas recovery of renal function was associated with decreased mortality and better ECOG and CFS ratings. Our data suggest that restoration of initial dysnatremia and acute kidney injury during acute geriatric care may benefit in-hospital survival and functional status at discharge.
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17
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Refardt J, Pelouto A, Potasso L, Hoorn EJ, Christ-Crain M. Hyponatremia Intervention Trial (HIT): Study Protocol of a Randomized, Controlled, Parallel-Group Trial With Blinded Outcome Assessment. Front Med (Lausanne) 2021; 8:729545. [PMID: 34552947 PMCID: PMC8450416 DOI: 10.3389/fmed.2021.729545] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Hyponatremia is the most common electrolyte disorder with a prevalence of up to 30% in hospitalized patients. In contrast to acute hyponatremia where the need for immediate treatment is well-recognized, chronic hyponatremia is often considered not clinically relevant. This is illustrated by reports showing that appropriate laboratory tests are ordered in <50% of patients and that up to 75% are still hyponatremic at discharge. At the same time, emerging evidence suggests an association between hyponatremia and adverse events including increased risk of mortality and rehospitalization. Methods: This is a randomized (1:1 ratio) controlled, superiority, parallel-group international multi-center trial with blinded outcome assessment. In total 2,278 participants will be enrolled. Participants will be randomly assigned to undergo either targeted correction of plasma sodium levels or standard of care during hospitalization. The primary outcome is the combined risk of death or re-hospitalization within 30 days. Discussion: All data on hyponatremia and mortality are derived from observational studies and often lack methodologic robustness. Consequently, the direct impact of hyponatremia on mortality and rehospitalization risk is still debated, resulting in a clinical equipoise whether in-hospital chronic hyponatremia should be treated or not. Therefore, a randomized controlled trial is required to study whether targeted plasma sodium correction reduces the risk of mortality and rehospitalization associated with hyponatremia. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03557957.
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Affiliation(s)
- Julie Refardt
- Departments of Endocrinology, Diabetology and Metabolism University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Clinical Trial Unit, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Anissa Pelouto
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Laura Potasso
- Departments of Endocrinology, Diabetology and Metabolism University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Clinical Trial Unit, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Mirjam Christ-Crain
- Departments of Endocrinology, Diabetology and Metabolism University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Clinical Trial Unit, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
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18
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Guo CY, Chan CH, Chou YC, Sung SH, Cheng HM. A statistical predictive model consistent within a 5-year follow-up period for patients with acute heart failure. J Chin Med Assoc 2020; 83:1008-1013. [PMID: 32773590 PMCID: PMC7647426 DOI: 10.1097/jcma.0000000000000403] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute heart failure (AHF) is a major and rapidly growing health problem responsible for millions of hospitalizations annually. Due to a high proportion of in-hospital mortality and postdischarge rehospitalization and mortality, a prompt strategy for risk stratification and subsequently tailored therapy is desirable to help improve clinical outcomes. The AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) and AHEAD-U (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus, U: uric acid) are popular prognostic scoring systems. However, only a specific follow-up period is considered in these systems, and whether their predictive capability is still accurate in a significantly shorter or longer follow-up period is not known. METHODS In this research, we adapted extensive statistical approaches based on the Cox model to explore consistent risk factors in various follow-up durations. Results showed that six factors, namely, hemoglobin level, age, sodium level, blood urea nitrogen level, atrial fibrillation, and high-density lipoprotein level could be used to establish a new prognostic model, which was referred to as HANBAH. For a simple clinical application, the HANBAH scoring system, with scores from 0 to 6, was developed using several statistical models. RESULTS Based on an evaluation using the conventional statistical approaches, such as the Akaike information criterion, concordance statistic, and Cox area under the curve, the HANBAH scoring system consistently outperformed other strategies in predicting short- and long-term mortality. Notably, an independent replication study also revealed similar results. In addition, a modern machine learning technique using the support vector machine confirmed its superior performance. CONCLUSION The use of the HANBAH scoring system, which is a clinically friendly tool, was proposed, and its efficacy in predicting the mortality rates of patients with AHF regardless of the follow-up duration was independently validated.
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Affiliation(s)
- Chao-Yu Guo
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chien-Hui Chan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Chin Chou
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Hsien Sung
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Address correspondence: Dr. Shih-Hsien Sung and Dr. Hao-Min Cheng, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (S.-H. Sung) and (H.-M. Cheng)
| | - Hao-Min Cheng
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Address correspondence: Dr. Shih-Hsien Sung and Dr. Hao-Min Cheng, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (S.-H. Sung) and (H.-M. Cheng)
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19
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Su Y, Ma M, Zhang H, Pan X, Zhang X, Zhang F, Lv Y, Yan C. Prognostic value of serum hyponatremia for outcomes in patients with heart failure with preserved ejection fraction: An observational cohort study. Exp Ther Med 2020; 20:101. [PMID: 32973950 PMCID: PMC7507018 DOI: 10.3892/etm.2020.9231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022] Open
Abstract
Hyponatremia is a risk factor associated with poor prognosis in patients with heart failure (HF) with reduced ejection fraction. However, whether hyponatremia has a similar role in patients with HF with preserved ejection fraction (HFpEF) has remained controversial. Therefore, the present study aimed to investigate the clinical characteristics and 24-month prognostic profile of a cohort of patients with HFpEF in China. From a registered observational cohort study on 1,027 subjects with HF, 496 patients with HFpEF were included. The association between baseline hyponatremia on admission and 24-month adverse outcomes (including all-cause mortality, re-hospitalization for HF and stroke) was analyzed using logistic regression with the Cox proportional hazards model. Of the 496 patients with HFpEF with a mean age of 72.8 years and proportion of males of 53.0%, 71 patients were diagnosed with hyponatremia. Furthermore, 29 patients (5.8%) were lost to follow-up. The hyponatremia group had lower blood pressure and serum hemoglobin, higher N-terminal pro B-type natriuretic peptide (NT-proBNP) and D-dimer, more patients with a history of atrial fibrillation and a higher proportion of spironolactone and loop diuretic use. According to a multivariate regression analysis, New York Heart Association functional classes III-IV and a serum NT-proBNP level above the median were risk factors for hyponatremia, while higher systolic blood pressure and β-blocker use were protective factors against hyponatremia. In the Kaplan-Meier analysis, hyponatremia was associated with all-causes of mortality, re-hospitalization for HF and a poor prognosis for patients suffering from strokes (log-rank P<0.05 for all 3 endpoints). On multivariate logistic regression analysis with the Cox proportional hazard model, hyponatremia was an independent predictor of three adverse outcomes [all-cause mortality: Hazard ratio (HR)=1.54, 95% CI=1.07-2.91, P=0.034; re-hospitalization for heart failure: HR=1.28, 95% CI=1.16-2.47, P=0.013; stroke: HR=1.78, 95% CI=1.04-2.89, P=0.016]. Collectively, the present results suggested that hyponatremia on admission was significantly associated with all-cause mortality, re-hospitalization and stroke within 24 months in a cohort of hospitalized patients with HFpEF in China. Thus, hyponatremia should be carefully monitored and frequently adjusted in patients with HFpEF (NCT04062500).
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Affiliation(s)
- Yang Su
- Department of Cardiology, Shanghai Tenth People's Hospital, Qidong People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
| | - Mengqiu Ma
- Department of Cardiology, Shanghai Tenth People's Hospital, Qidong People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
| | - Hengbin Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Qidong People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
| | - Xin Pan
- Department of Geriatrics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
| | - Xianling Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Qidong People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
| | - Fenglei Zhang
- Department of Cardiology, Shanghai Yoda Cardiothoracic Hospital, Shanghai 200012, P.R. China
| | - Yangbo Lv
- Department of Cardiology, Shanghai Tenth People's Hospital, Qidong People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China.,Department of Cardiology, Shanghai Yoda Cardiothoracic Hospital, Shanghai 200012, P.R. China
| | - Chunxi Yan
- Department of Cardiology, Shanghai Tenth People's Hospital, Qidong People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
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20
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Ayus JC, Fuentes N, Go AS, Achinger SG, Moritz ML, Nigwekar SU, Waikar SS, Negri AL. Chronicity of Uncorrected Hyponatremia and Clinical Outcomes in Older Patients Undergoing Hip Fracture Repair. Front Med (Lausanne) 2020; 7:263. [PMID: 32695787 PMCID: PMC7338672 DOI: 10.3389/fmed.2020.00263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Chronic hyponatremia is a risk factor for hip fracture but remains uncorrected in most patients. This study evaluated if preoperative chronicity of uncorrected hyponatremia influences outcomes after hip fracture repair. Materials and Methods: Evaluated were older patients hospitalized for hip fracture repair between 2007 and 2012 with plasma sodium measured at admission and ≥1 preadmission outpatient measurement. Patients were classified as being normonatremic (NN; plasma sodium 135–145 mmol/L), chronic prolonged hyponatremia (CPH; ≥2 consecutive plasma sodium values <135 mmol/L over >90 days), or recent hyponatremia (one plasma sodium <135 mmol/L within 30 days before admission with previously normal plasma sodium). Length of hospital stay, in-hospital death, post-operative complications, 30-day readmission, and long-term mortality were the evaluated outcomes. Multivariable Cox regression was used to evaluate the association of hyponatremia status with outcomes. Results: Among 1,571 eligible patients, 76.7% were NN, 14% had CPH, and 9.1% had RH. Compared with NN patients, CHN patients were older and had more prior heart failure, alcoholism, and anticonvulsant drug use. In multivariable analyses, neither CPH or RH was associated with hospital length of stay, in-hospital or 30-day death, or 30-day readmission, while RH was associated with post-operative sepsis [adjusted odds ratio (aOR) 1.84, 95% CI: 1.01–3.35). Only CPH was independently associated with long-term all-cause death (OR 1.53, 95% CI: 1.12–2.09). Conclusions: Hyponatremia affects nearly 25% of patients undergoing hip fracture repair. Preoperative chronic untreated hyponatremia is associated with increased post-operative mortality following surgical repair of a hip fracture in older patients. Future studies should evaluate if correction of hyponatremia could decrease long-term mortality after hip fracture repair.
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Affiliation(s)
- Juan Carlos Ayus
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Department of Nephrology, University of California-Irvine, Irvine, CA, United States.,Renal Consultants, Houston, TX, United States
| | - Nora Fuentes
- Internal Medicine Research Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.,Research Department, Private Community Hospital, Mar del Plata, Argentina.,Research Group of Non-communicable Chronic Diseases, Higher School of Medicine, National University of Mar del Plata, Mar del Plata, Argentina
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.,Departments of Medicine (Nephrology), Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States.,Departments of Medicine (Nephrology), Health Research and Policy, Stanford University, Palo Alto, CA, United States
| | - Steven G Achinger
- Department of Nephrology, Watson Clinic, Lakeland, FL, United States
| | - Michael L Moritz
- Division of Nephrology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, The University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Sagar U Nigwekar
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Sushrut S Waikar
- Nephrology Section, Boston University Medical Center, Boston, MA, United States
| | - Armando Luis Negri
- Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires, Argentina
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Yatsu S, Kasai T, Daida H. Reply to Comments on Relationship between Hypoalbuminemia on Admission and Long-term Mortality in Patients with Acute Decompensated Heart Failure. Intern Med 2019; 58:3491. [PMID: 31327847 PMCID: PMC6928508 DOI: 10.2169/internalmedicine.3411-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan
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22
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Rodriguez M, Hernandez M, Cheungpasitporn W, Kashani KB, Riaz I, Rangaswami J, Herzog E, Guglin M, Krittanawong C. Hyponatremia in Heart Failure: Pathogenesis and Management. Curr Cardiol Rev 2019; 15:252-261. [PMID: 30843491 PMCID: PMC8142352 DOI: 10.2174/1573403x15666190306111812] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 12/11/2022] Open
Abstract
Hyponatremia is a very common electrolyte abnormality, associated with poor short- and long-term outcomes in patients with heart failure (HF). Two opposite processes can result in hyponatremia in this setting: Volume overload with dilutional hypervolemic hyponatremia from congestion, and hypovolemic hyponatremia from excessive use of natriuretics. These two conditions require different therapeutic approaches. While sodium in the form of normal saline can be lifesaving in the second case, the same treatment would exacerbate hyponatremia in the first case. Hypervolemic hyponatremia in HF patients is multifactorial and occurs mainly due to the persistent release of arginine vasopressin (AVP) in the setting of ineffective renal perfusion secondary to low cardiac output. Fluid restriction and loop diuretics remain mainstay treatments for hypervolemic/dilutional hyponatremia in patients with HF. In recent years, a few strategies, such as AVP antagonists (Tolvaptan, Conivaptan, and Lixivaptan), and hypertonic saline in addition to loop diuretics, have been proposed as potentially promising treatment options for this condition. This review aimed to summarize the current literature on pathogenesis and management of hyponatremia in patients with HF.
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Affiliation(s)
- Mario Rodriguez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai St' Luke and Mount Sinai West, New York, NY, United States.,Cardiac Intensive Care Unit, Mount Sinai St' Luke, Mount Sinai Heart, New York, NY, United States
| | - Marcelo Hernandez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai St' Luke and Mount Sinai West, New York, NY, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, MS, United States
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Iqra Riaz
- Department of Nephrology, Einstein Medical Center, Philadelphia, PA, United States
| | - Janani Rangaswami
- Department of Nephrology, Einstein Medical Center, Philadelphia, PA, United States
| | - Eyal Herzog
- Cardiac Intensive Care Unit, Mount Sinai St' Luke, Mount Sinai Heart, New York, NY, United States
| | - Maya Guglin
- Division of Cardiology, Mechanical Assisted Circulation, Gill Heart Institute, University of Kentucky, Kentucky, KY, United States
| | - Chayakrit Krittanawong
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai St' Luke and Mount Sinai West, New York, NY, United States.,Cardiac Intensive Care Unit, Mount Sinai St' Luke, Mount Sinai Heart, New York, NY, United States
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23
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Shah V, Jahan N. Prognostic Significance of Hyponatremia in ST-elevation Myocardial Infarction/Heart Failure Patients. Cureus 2019; 11:e5673. [PMID: 31720149 PMCID: PMC6823034 DOI: 10.7759/cureus.5673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022] Open
Abstract
ST-elevation myocardial infarction (STEMI) and heart failure (HF) are common, big-budget, debilitating and expanding diseases. Cardiovascular diseases, especially STEMI and heart failure have been known to cause 17.3 million deaths worldwide annually. Hyponatremia, delineated as a serum sodium (sNa) concentration <135 mmol/l, is a frequently seen electrolyte disturbance in practice and the prevalence, clinical impact; the prognostic factor of low SNa in STEMI/heart failure patients vary widely. The aim of this review is to assess its existence and comparing survival difference between hypo and normonatremic patients. A comprehensive review of the published articles was conducted using database PubMed. We found a total of over 1400 articles. The inclusion criteria used for this review were age >65 years, published within the last 10 years, written in English, performed on human subjects and of studies such as reviews and randomized controlled trials (RCTs), especially for heart failure MeSH words. By applying this inclusion criterion, we found out 40 relevant articles which included 26 cohort studies, four clinical trials, four review articles, and six RCTs. In the analysis of 7,06,899 patients with STEMI/heart failure, hyponatremia was significantly linked to causing all-cause mortality, both short and long term (hazard ratio [HR] as continuous variable: 1.06; 95% confidence interval [CI]: 1.01-1.11; P = 0.026; HR as categorical variable: 1.71; 95% CI: 1.06-2.75; P = 0.028). The rates of rehospitalization were also higher (odds ratio, 1.68; 95% confidence interval, 1.32-2.14) along with prolonged hospital stays as well as a greater cost burden as compared to patients with normal serum sodium. It was existent not only in patients with reduced ejection fraction (HFrEF) but also in subjects with preserved ejection fraction (HFpEF) (HR 1.40, 95% CI 1.12 to 1.75, P = 0.004). Rise of first follow-up and discharge sodium does seem to have positive linkage on survival as well (hazard ratio [HR] 0.429, 95% CI 0.191-0.960, P = 0.04). Hyponatremia is the most frequently encountered electrolyte abnormality in clinical practice and has a poor prognosis in both STEMI and heart failure patients. It exacerbates both short and long term mortality, rehospitalization rates, as well as the average length of stay in the hospital. Although it is still a mystery whether hyponatremia is just a marker of iller patients or the core of poor prognosis in patients with STEMI and HF, one thing is certain: timely recognition of patients at risk for developing hyponatremia could help to commence early treatment.
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Affiliation(s)
- Vraj Shah
- Cardiology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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24
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Kammerlander AA. With a grain of salt: Sodium levels in heart failure. Int J Cardiol 2019; 290:125-126. [PMID: 31133432 DOI: 10.1016/j.ijcard.2019.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
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Perturbations of pulsatile hemodynamics and clinical outcomes in patients with acute heart failure and reduced, mid-range or preserved ejection fraction. PLoS One 2019; 14:e0220183. [PMID: 31381586 PMCID: PMC6681962 DOI: 10.1371/journal.pone.0220183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 07/10/2019] [Indexed: 12/28/2022] Open
Abstract
Background Heart failure with mid-range ejection fraction (HFmrEF) has been proposed as a new phenotype of heart failure. We therefore investigated the pulsatile hemodynamic characteristics and outcomes in patients with HFmrEF, in comparison with those with reduced (HFrEF) or preserved (HFpEF) ejection fraction. Methods The study was composed of two cohorts of patients hospitalized due to acute heart failure. Pulsatile hemodynamic measures, including carotid-femoral pulse wave velocity (cf-PWV), carotid pulse pressure (cPP), amplitude of the backward pressure wave (Pb) and carotid augmentation index (cAIx), were recorded on admission and before discharge in Cohort A (n = 230, mean age 69.9 ±15.4 years), and long-term follow-up was performed in Cohort B (n = 2677, mean age 76.3 ± 33.4 years). Results In Cohort A, patients with HFmrEF had persistently greater cf-PWV, cPP, Pb, and cAI than those with HFrEF, both on admission and before discharge. In contrast, patients with HFmrEF and HFpEF had similar pulsatile hemodynamic characteristics. In cohort B, patients with HFmrEF and HFrEF had similar three-year mortality rates and both were significantly higher than that in patients with HFpEF (both P values < 0.05). Conclusions Patients with HFmrEF were characterized by a worse left ventricular systolic function than patients with HFpEF and excessive wave reflections than patients with HFrEF. Future studies are required to confirm that the unfavorable ventriculo-arterial coupling in HFmrEF might play a role in the pathogenesis of high long-term mortality in these patients.
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26
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Miles JA, Quispe R, Mehlman Y, Patel K, Lama Von Buchwald C, You JY, Sokol S, Faillace RT. Racial differences and mortality risk in patients with heart failure and hyponatremia. PLoS One 2019; 14:e0218504. [PMID: 31216316 PMCID: PMC6583993 DOI: 10.1371/journal.pone.0218504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/04/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyponatremia is a well-established poor prognostic marker in patients with heart failure. Whether the mortality risk is comparable among different races of patients with heart failure and hyponatremia is unknown. MATERIALS AND METHODS Consecutive patients admitted with acute decompensated heart failure and an admission sodium level<135 mEq/L from 1/1/2001 through 12/31/10 were identified. Patients were divided into four groups based on self-reported race: white, African American, Hispanic and other. African Americans were used as the reference group for statistical analysis. The primary outcome was all-cause mortality. RESULTS We included 4,343 patients, from which 1,356 (31%) identified as white, 1,248 (29%) as African American, 780 (18%) as Hispanic and 959 (22%) as other. During a median follow-up of 23 months, a total of 2,384 patients died: 678 were African American, 820 were white, 298 were Hispanic and 588 were other. After adjusting for baseline demographics, comorbidities and medication use, Hispanic patients had a 45% less risk of death as compared to African Americans (HR .55, CI .48-.64, p<0.05). There was no difference in mortality between white and African American patients (HR 1.04, CI .92-1.2, p = 0.79). CONCLUSION Hispanic patients admitted for heart failure and who were hyponatremic on admission had an independent lower risk of mortality compared to other groups. These findings may be due to the disparate activity of the renin-angiotensin-aldosterone system among various racial groups. This observational study is hypothesis generating and suggests that treatment of patients with heart failure and hyponatremia should perhaps be focused more on renin-angiotensin-aldosterone system reduction in certain racial groups, yet less in others.
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Affiliation(s)
- Jeremy A. Miles
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
- * E-mail:
| | - Renato Quispe
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Yonatan Mehlman
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kavisha Patel
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Claudia Lama Von Buchwald
- Department of Medicine, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Jee Young You
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Seth Sokol
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Robert T. Faillace
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
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27
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Imran TF, Kurgansky KE, Patel YR, Orkaby AR, McLean RR, Ho YL, Cho K, Gaziano JM, Djousse L, Gagnon DR, Joseph J. Serial sodium values and adverse outcomes in heart failure with preserved ejection fraction. Int J Cardiol 2019; 290:119-124. [PMID: 30929975 DOI: 10.1016/j.ijcard.2019.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/23/2019] [Accepted: 03/19/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of our study is to examine whether serial measurements of serum sodium values after diagnosis identify a higher-risk subset of patients with heart failure with preserved ejection fraction. METHODS We identified 50,932 subjects with HFpEF with 759,577 recorded sNa measurements (mean age 72 ± 11 years) using a validated algorithm in the VA national database from 2002 to 2012. We examined the association of repeated measures of sNa with mortality using a multivariable Cox proportional hazards model. RESULTS After a median follow-up of 2.9 years (IQR: 1.2-5.4), 19,011 deaths occurred. After adjusting for age, sex, race, BMI, glomerular filtration rate, potassium, coronary artery disease, hypertension, hyperlipidemia, atrial fibrillation, pulmonary disease, diabetes, anemia, and medications, we found J-shaped associations of serum sodium with mortality. HRs for all-cause mortality were 2.48 (95% CI: 2.38-2.60) for the sNA 115.00-133.99 category; and 1.40 (95% CI: 1.35-1.46) for the sNA 143.00-175.00 category compared to the 137.01-140.99 category (ref). We used generalized estimating equation-based negative binomial regression to compute the incidence density ratios (IDR) to examine days hospitalized for heart failure and for all causes. There were a total of 1,275,614 days of all-cause hospitalization and 104,006 days of heart-failure hospitalization. The IDRs for the lowest sNA group were 2.03 (95% CI: 1.90-2.18) for all-cause hospitalization and 1.73 (95% CI: 1.39-2.16) for heart-failure hospitalization. CONCLUSIONS Our findings suggest that monitoring of serum sodium values during longitudinal follow-up can identify HFpEF patients at risk of adverse outcomes.
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Affiliation(s)
- Tasnim F Imran
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Medicine, Cardiology Section, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Katherine E Kurgansky
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America
| | - Yash R Patel
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America; Mount Sinai St Luke's & Mount Sinai West Hospitals, New York, NY, United States of America
| | - Ariela R Orkaby
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Geriatric, Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States of America
| | - Robert R McLean
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America; Institute for Aging Research, Hebrew Senior Life, Boston, MA, United States of America
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America
| | - Kelly Cho
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Luc Djousse
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - David R Gagnon
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Jacob Joseph
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, United States of America; Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
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28
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Abebe TB, Gebreyohannes EA, Tefera YG, Bhagavathula AS, Erku DA, Belachew SA, Gebresillassie BM, Abegaz TM. The prognosis of heart failure patients: Does sodium level play a significant role? PLoS One 2018; 13:e0207242. [PMID: 30408132 PMCID: PMC6224129 DOI: 10.1371/journal.pone.0207242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/26/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Heart failure (HF), a major cardiovascular disorder, remains a grievous clinical condition regardless of advances in medical care. Hyponatremia is classified as a serum sodium concentration of <135 mEq/L, and the prevalence, clinical impact and prognostic factor of hyponatremia in heart failure patients varies widely. The current study was conducted with the aim of assessing the prevalence of hyponatremia in patients hospitalized with a diagnosis of HF and comparing baseline clinical characteristic of HF patients based on their sodium status. Survival difference between patients with hyponatremia and normonatremia was also assessed and the clinical prognostic indicators of overall mortality in HF patients were evaluated. Method A retrospective cohort study was conducted to assess medical records of heart failure patients who were admitted to Gondar University Referral Hospital. Patients were categorized based on their sodium level status at their first admission to the internal medicine department. Each patient was assigned to either of the following groups: hyponatremia if sodium < 135 mmol/L, or normonatremia if sodium ≥ 135 mmol/L. Result Among 388 participants, the prevalence of hyponatremia in the study cohorts was 51.03%. Kaplan-Meier survival curves showed that there was a significant difference in survival status of HF patients among the two cohorts (Log—Rank test, P <0.0001). Hence, patients with normal sodium levels had a higher chance of survival over hyponatremic patients. Multivariate Cox regression has revealed a statistically significant association of mortality with the following variables: advanced age (AHR = 1.035 (1.012–1.058), P = 0.003), hyponatremia (AHR = 4.003 (1.778–9.009), P = 0.001), higher creatinine level (AHR = 1.929 (1.523–2.443), P = <0.0001) and, prescription of angiotensin-converting enzyme inhibitors (AHR = 0.410 (0.199–0.842), P = 0.015) and spironolactone (AHR = 0.511 (0.275–0.949), P = 0.033. Conclusion In conclusion, hyponatremia is one of the crucial factors in the clinical prognosis of heart failure patients. However, as other prognostic factors (i.e. medication, creatine level, and age) also played vital roles in overall survival, well-controlled clinical trials (complete with medication dosing, laboratory outputs and long-term prospective follow up) are required to further study the impact of hyponatremia in HF patient’s prognosis in low income nations.
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Affiliation(s)
- Tamrat Befekadu Abebe
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Learning, Informatics, Management, and Ethics (LIME), Karolinska Institutet, Solna, Sweden
- * E-mail: ,
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yonas Getaye Tefera
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Internal Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Daniel Asfaw Erku
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Sewunet Admasu Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Begashaw Melaku Gebresillassie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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29
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Change in natremia as a prognostic marker in patients with acute heart failure. Int J Cardiol 2018; 269:222-223. [DOI: 10.1016/j.ijcard.2018.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022]
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30
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Hiki M, Kasai T, Yatsu S, Murata A, Matsumoto H, Kato T, Suda S, Miyazaki T, Takagi A, Daida H. Relationship Between Serum Sodium Level Within the Low-Normal Range on Admission and Long-Term Clinical Outcomes in Patients with Acute Decompensated Heart Failure. Int Heart J 2018; 59:1052-1058. [PMID: 30101847 DOI: 10.1536/ihj.17-524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although hyponatremia during hospitalization for acute decompensated heart failure (ADHF) is reportedly related with poor prognosis, the available data regarding the impact of serum sodium level within the low-normal range at admission on clinical events in patients with ADHF is limited.We studied eligible patients admitted to our institution in 2007-2011. All the patients were categorized into 3 groups according to the admission serum sodium levels of < 135 mmol/L (hyponatremia), ≥ 135 and < 140 mmol/L (low-normal range), or ≥ 140 mmol/L (normal range). The association between admission serum sodium levels and long-term clinical events, a composite of all-cause deaths and re-hospitalizations for ADHF, was assessed by multivariable Cox proportional analysis.Of the 584 eligible patients, 208 (35.6%) were in the low-normal range and 99 (16.9%) had hyponatremia on admission. On multivariable analysis, compared with those with a sodium level ≥ 140 mmol/L, patients with hyponatremia were at increased risk for clinical events (hazard ratio [HR], 1.53; P = 0.041), whereas the HR of those in the low-normal range was attenuated and insignificant (HR, 1.08; P = 0.625). However, the HR of each category increased significantly as sodium level decreased (P value for HR trend, 0.024). In addition, when serum sodium level was treated as a continuous variable, the lower the serum sodium level, the greater the risk of clinical events (P = 0.012). The cut-off value of serum sodium level to predict mortality was < 138 mmol/L.In conclusion, a low serum sodium level on admission for ADHF, even if low-normal, can increase the risk of long-term mortality and/or re-hospitalization for ADHF.
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Affiliation(s)
- Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Azusa Murata
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Hiroki Matsumoto
- Department of Cardiovascular Medicine, Juntendo University School of Medicine.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
| | - Takao Kato
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University School of Medicine.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuro Miyazaki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Atsutoshi Takagi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
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Rise of first follow-up sodium in patients hospitalized with acute heart failure is associated with better outcomes. Int J Cardiol 2018; 269:201-206. [PMID: 30224032 DOI: 10.1016/j.ijcard.2018.06.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The prognostic effect of the direction of change in sodium (Na) level from admission to subsequent check in patients with acute heart failure (HF) has not been previously explored. METHODS The ESCAPE trial data was utilized to study whether the rise of 1st follow-up Na (at day 3) relative to admission (among patients with admission hyponatremia) is associated with favorable outcomes. The study endpoints were all-cause rehospitalization and a composite of death, rehospitalization and cardiac transplant, both up to 6-month after discharge. RESULTS Patients with rise of 1st follow-up Na (n = 43) had an average admission Na of 130.1 meq/L which increased to 134 meq/L at day 3 (P < 0.001), while patients without rise of 1st follow up Na (n = 46) had an admission Na of 131 meq/L which decreased to 128.9 meq/L at day 3 (P < 0.001). There was an inverse association between the magnitude of change in Na level from admission to day 3 and the magnitude of change in blood urea nitrogen (BUN, r = -0.304, P = 0.004), creatinine (r = -0.401, P < 0.001) and weight (r = -0.279, P = 0.011) during the same time frame. Among those 89 cases, 56 (63%) were rehospitalized and 70 (79%) experienced the composite endpoint. Patients without rise in 1st follow-up Na had higher frequency of rehospitalization (76.1% vs. 48.8%, univariate Odds ratio (OR) 1.778, 95% CI 1.174-2.693, P = 0.009) and composite endpoint (89.1% vs. 67.4%, univariate OR 1.779, 95% CI 1.208-2.619, P = 0.017), compared with those with Na rise. Cox regression analysis showed that rise in 1st follow-up Na was independently associated with reduced rehospitalization (Hazard ratio (HR) 0.429, 95% CI 0.191-0.960, P = 0.04) and the composite endpoint (HR 0.430, 95% CI 0.201-0.920, P = 0.03) after covariate adjustment. CONCLUSION Rise of first follow-up Na in patients with HF decompensation and hyponatremia on admission is associated with favorable intermediate-term outcomes.
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Zaninović Jurjević T, Dvornik Š, Kovačić S, Matana Kaštelan Z, Brumini G, Matana A, Zaputović L. A simple prognostic model for assessing in-hospital mortality risk in patients with acutely decompensated heart failure. Acta Clin Belg 2018; 74:102-109. [DOI: 10.1080/17843286.2018.1483562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - Štefica Dvornik
- Department for Laboratory Diagnostics, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Slavica Kovačić
- Department for Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | | | - Gordana Brumini
- Faculty of Health Studies, Department for Basic Medical Sciences University of Rijeka, Rijeka, Croatia
| | - Ante Matana
- Department for Cardiovascular Diseases, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Luka Zaputović
- Department for Cardiovascular Diseases, Clinical Hospital Centre Rijeka, Rijeka, Croatia
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Prognostic Significance of Discharge Hyponatremia in Heart Failure Patients With Normal Admission Sodium (from the ESCAPE Trial). Am J Cardiol 2017; 120:607-615. [PMID: 28669488 DOI: 10.1016/j.amjcard.2017.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 11/21/2022]
Abstract
Hyponatremia in acute decompensated heart failure (HF) is indicative of a poor prognosis and predicts morbidity and mortality. We explored the predictive utility of hyponatremia at the time of hospital discharge among HF patients with normal admission sodium (Na). Characteristics and outcomes of HF patients enrolled in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial, who had normal Na on admission, were compared between those who were hyponatremic (Na <135 meq/L) or normonatremic on discharge. Three hundred six patients with normal admission Na had either hyponatremia (n = 86) or normal Na (n = 220) on discharge. Compared with patients with normal Na on discharge, hyponatremic patients were younger (p = 0.004), with lower discharge systolic (p <0.001) and diastolic (p = 0.004) blood pressure, higher discharge blood urea nitrogen (p = 0.011) despite similar creatinine (p = 0.566), lower ejection fraction (p = 0.007), and higher left ventricular end-diastolic (p = 0.028) and end-systolic (p = 0.007) dimensions. Despite comparable congestion on hospital admission, patients with discharge hyponatremia had a higher degree of decongestion throughout hospitalization evident in the significantly greater admission to discharge weight loss (p = 0.044) and admission to discharge reduction in inferior vena cava diameter (p = 0.014). Despite longer initial hospitalization (p = 0.004), total duration in hospital at 30 days (p = 0.004) and 6 months (p = 0.045), there were no significant differences between patients with discharge hyponatremia versus normal Na on discharge regarding rehospitalization (p = 0.386), all-cause mortality (p = 0.440), and composite of death, cardiac rehospitalization, and cardiac transplant (p = 0.799), all up to 6-month following randomization. Restricted cubic spline analysis also showed no significant relationships between discharge Na and the aforementioned 3 outcomes. Cox proportional hazards regressions showed that discharge hyponatremia did not significantly predict any of the 3 outcomes after adjustment for imbalances at baseline. Among patients with discharge hyponatremia, a poor outcome was more likely if they were also hyponatremic on admission: the composite end point occurred in 69.2% of those also hyponatremic on admission versus 51.2% of those with normal Na on admission but decreased Na on discharge (p = 0.045). Because the median discharge Na level in the discharge hyponatremia group was 132 meq/L, our findings suggest a benign nature of mild discharge hyponatremia in HF patients with normal admission Na.
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Matsue Y, Yoshioka K, Suzuki M, Torii S, Yamaguchi S, Fukamizu S, Ono Y, Fujii H, Kitai T, Nishioka T, Sugi K, Onishi Y, Noda M, Kagiyama N, Satoh Y, Yoshida K, Goldsmith SR. Prognostic importance of sodium level trajectory in acute heart failure. Heart Vessels 2017; 32:1498-1505. [PMID: 28698994 DOI: 10.1007/s00380-017-1020-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
Abstract
Low sodium levels are strongly associated with poor prognosis in acute heart failure (AHF); however, the prognostic impact of the sodium level trajectory overtime has not been determined. A secondary analysis of the AQUAMARINE study in which patients with AHF and renal impairment were randomized to receive either tolvaptan or conventional treatment was performed. Sodium levels were evaluated at the baseline and at 6, 12, 24, and 48 h. We defined 'sodium dipping' as sodium level falling below the baseline level at any time point. The primary endpoint was the combined event of all-cause death and heart failure rehospitalization during follow-up. The analysis included 184 patients with a median follow-up of 21.1 months. Sodium levels more steeply increased during the 48 h in patients without events as compared to sodium levels in patients with events (P = 0.018 in linear-mixed effect model). The sodium dipping group (n = 100; 54.3%) demonstrated significantly less urine output, less body weight reduction, and poorer diuretic response within 48 h compared to the non-dipping group. The sodium dipping group was also significantly associated with a low combined-event-free survival after adjustment for other prognostic factors (HR 1.97; 95% CI 1.06-3.38; P = 0.033). The trajectory of sodium levels during the acute phase is associated with the prognosis of patients with AHF independently of the baseline sodium level.
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Affiliation(s)
- Yuya Matsue
- Department of Cardiology, Kameda Medical Center, 929 Higashi-Cho, Kamogawa, Chiba, Japan.
| | - Kenji Yoshioka
- Department of Cardiology, Kameda Medical Center, 929 Higashi-Cho, Kamogawa, Chiba, Japan
| | - Makoto Suzuki
- Department of Cardiology, Kameda Medical Center, 929 Higashi-Cho, Kamogawa, Chiba, Japan
| | - Sho Torii
- Department of Cardiology, School of Medicine, Tokai University, Kanagawa, Japan
| | - Satoshi Yamaguchi
- Department of Cardiology, Tomishiro Central Hospital, Okinawa, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Yuichi Ono
- Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan
| | - Hiroyuki Fujii
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshihiko Nishioka
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kaoru Sugi
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Yuko Onishi
- Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa, Japan
| | - Makoto Noda
- Department of Cardiology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yasuhiro Satoh
- Department of Cardiology, National Disaster Medical Center, Tokyo, Japan
| | - Kazuki Yoshida
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Steven R Goldsmith
- Division of Cardiology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
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Jin M, Wei S, Gao R, Wang K, Xu X, Yao W, Zhang H, Zhou Y, Xu D, Zhou F, Li X. Predictors of Long-Term Mortality in Patients With Acute Heart Failure. Int Heart J 2017; 58:409-415. [PMID: 28496020 DOI: 10.1536/ihj.16-219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To investigate parameters which were related with long-term mortality in patients hospitalized for acute heart failure (AHF).A total of 287 patients with AHF presenting to the First Affiliated Hospital of Nanjing Medical University were enrolled into the registry from April 2012 to January 2015. The primary endpoint was all-cause mortality within 1 year; the association between variables and prognosis was assessed after 1 year.Among the 287 patients, 17 did not continue follow-up and 47 (17.4%) passed away. Baseline NT-proBNP and sST2 concentrations were higher amongst deceased than among survivors (P < 0.001). Serum sodium concentrations of patients who died were lower (P < 0.001). In receiver operator characteristics (ROC) analyses, the area under the curve (AUC) values for NT-proBNP, sST2, and serum sodium to predict 1-year mortality were 0.699 (95%CI 0.639-0.755), 0.692, (95%CI 0.634-0.747), and 0.694 (95%CI 0.634-0.750), respectively. The optimal cut-off points for NT-proBNP, sST2, and serum sodium were 2137.0 ng/L, 35.711 ng/mL, and 136.6 mmol/L, respectively. In Cox regression analysis, ln-transformed NT-proBNP (HR 1.546, P = 0.039), ln-transformed sST2 (HR1.542, P = 0.049), and serum sodium (HR 0.880, P = 0.000) values reliably predicted long-term mortality after multivariable adjustment.In patients with acute heart failure, NT-proBNP, sST2 and serum sodium are potential predictors of 1-year mortality.
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Affiliation(s)
- Mengchao Jin
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
| | - Siqi Wei
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
| | - Rongrong Gao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
| | - Kai Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
| | - Xuejuan Xu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
| | - Wenming Yao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
| | - Haifeng Zhang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
| | - Yanli Zhou
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
| | - Dongjie Xu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
| | - Fang Zhou
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
| | - Xinli Li
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University
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Thibodeau JT, Jenny BE, Maduka JO, Divanji PH, Ayers CR, Araj F, Amin AA, Morlend RM, Mammen PP, Drazner MH. Bendopnea and risk of adverse clinical outcomes in ambulatory patients with systolic heart failure. Am Heart J 2017; 183:102-107. [PMID: 27979033 DOI: 10.1016/j.ahj.2016.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/08/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recently, the symptom of bendopnea, that is, shortness of breath when bending forwards such as when putting on shoes, has been described in heart failure patients and found to be associated with higher ventricular filling pressures, particularly in the setting of low cardiac index. However, it is not known whether bendopnea is associated with clinical outcomes. METHODS In a prospective convenience sample of 179 patients followed in our heart failure disease management clinic, we determined the presence of bendopnea at the time of enrollment and ascertained clinical outcomes through 1 year of follow-up. We performed univariate and stepwise multivariable modeling to test the association of bendopnea with clinical outcomes. RESULTS Bendopnea was present in 32 of 179 (18%) subjects. At 1 year, those with versus without bendopnea were at increased risk of the composite endpoint of death, heart failure admission, inotrope initiation, left ventricular assist device implantation, or cardiac transplantation in univariate (hazard ratio [HR] 1.9, P < .05) but not multivariable (HR 1.9, P = .11) analysis. Bendopnea was more strongly associated with short-term outcomes including heart failure admission at 3 months in both univariate (HR 3.1, P < .004) and multivariable (HR 2.5, P = .04) analysis. CONCLUSIONS Bendopnea was associated with an increased risk of adverse outcomes in ambulatory patients with heart failure, particularly heart failure admission at 3 months.
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Community acquired versus hospital acquired hyponatremia in acute heart failure: Association with clinical characteristics and outcomes. Int J Cardiol 2016; 225:247-249. [PMID: 27736715 DOI: 10.1016/j.ijcard.2016.09.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/30/2016] [Indexed: 11/21/2022]
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Lu DY, Cheng HM, Cheng YL, Hsu PF, Huang WM, Guo CY, Yu WC, Chen CH, Sung SH. Hyponatremia and Worsening Sodium Levels Are Associated With Long-Term Outcome in Patients Hospitalized for Acute Heart Failure. J Am Heart Assoc 2016; 5:e002668. [PMID: 27009619 PMCID: PMC4943243 DOI: 10.1161/jaha.115.002668] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hyponatremia predicts poor prognosis in patients with acute heart failure (AHF). However, the association of the severity of hyponatremia and changes of serum sodium levels with long‐term outcome has not been delineated. Methods and Results The study population was drawn from the HARVEST registry (Heart Failure Registry of Taipei Veterans General Hospital), so that patients hospitalized for acute heart failure (AHF) composed this study. The National Death Registry was linked to identify the clinical outcomes of all‐cause mortality and cardiovascular death, with a follow‐up duration of up to 4 years. Among a total of 2556 patients (76.4 years of age, 67% men), 360 had on‐admission hyponatremia, defined as a serum sodium level of <135 mEq/L on the first day of hospitalization. On‐admission hyponatremia was a predictor for all‐cause mortality (hazard ratio and 95% CI: 1.43, 1.11–1.83) and cardiovascular mortality (1.50, 1.04–2.17), independent of age, sex, hematocrit, estimated glomerular filtration rate, left ventricular ejection fraction, and prescribed medications. Subjects with severe hyponatremia (<125 mEq/L) would even have worse clinical outcomes. During hospitalization, a drop of sodium levels of >3 mEq/L was associated with a marked increase of mortality than those with minimal or no drop of sodium levels. In addition, subjects with on‐admission hyponatremia and drops of serum sodium levels during hospitalization had an incremental risk of death (2.26, 1.36–3.74), relative to those with normonatremia at admission and no treatment‐related drop of serum sodium level in the fully adjusted model. Conclusions On‐admission hyponatremia is an independent predictor for long‐term outcomes in patients hospitalized for AHF. Combined the on‐admission hyponatremia with drops of serum sodium levels during hospitalization may make a better risk assessment in AHF patients.
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Affiliation(s)
- Dai-Yin Lu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Lun Cheng
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pai-Feng Hsu
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ming Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Yu Guo
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Chung Yu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Vallabhajosyula S, Varma MD, Vallabhajosyula S, Vallabhajosyula S. Association of hyponatremia with in-hospital outcomes in infective endocarditis: A 5-year review from an Indian Intensive Care Unit. Indian J Crit Care Med 2016; 20:597-600. [PMID: 27829716 PMCID: PMC5073775 DOI: 10.4103/0972-5229.192051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hyponatremia is commonly noted with cardiovascular disorders, but its role in infective endocarditis (IE) is limited to being a marker of increased morbidity in IE patients with intravenous drug use. This was a 5-year retrospective review from an Indian Intensive Care Unit (ICU). Patients >18 years with IE and available serum sodium levels were included in the study. Pediatric and pregnant patients were excluded from the study. Hyponatremia was defined as admission sodium <135 mmol/L. Detailed data were abstracted from the medical records. Primary outcomes were need for invasive mechanical ventilation, ICU length of stay, and in-hospital mortality. Secondary outcomes included development of acute kidney injury, acute decompensated heart failure (ADHF), acute respiratory distress syndrome, stroke, and severe sepsis in the ICU. Two-tailed P < 0.05 was considered statistically significant. Between January 2010 and December 2014, 96 patients with IE were admitted to the ICU with 85 (88.5%) (median age 46 [34.5-55] years, 51 [60.0%] males) meeting our inclusion criteria. The comorbidities, echocardiographic, and microbiological characteristics were comparable between patients with hyponatremia (56; 65.9%) and eunatremia (29; 34.1%). Median sodium in the hyponatremic cohort was 131 mmol/L (127.25-133) compared to the eunatremic cohort 137 mmol/L (135-139) (P < 0.001). The primary outcomes were not different between the two groups. Hyponatremia was associated more commonly with ADHF (12 [21.4%] vs. 0; P = 0.007) during the ICU stay. Hyponatremia is commonly seen in IE patients and is not associated with worse hospital outcomes. ADHF was seen more commonly in the hyponatremic patients in comparison to those with eunatremia.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Muralidhar D Varma
- Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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