Hyponatremia at discharge is associated with adverse prognosis in acute heart failure syndromes with preserved ejection fraction: a report from the JASPER registry

Association between hyponatremia and adverse clinical outcomes of heart failure: current evidence based on a systematic review and meta-analysis

Background

Heart failure (HF) is a global health challenge. The perturbations in fluid and electrolyte equilibrium, particularly the compromised sodium balance associated with HF lead to high mortality rates. Hence, elucidating the correlation between serum sodium levels and the prognosis of HF is of paramount importance. This study aimed to conduct a comprehensive meta-analysis to thoroughly investigate the interplay between hyponatremia and the prognostic outlook of individuals with HF.

Methods

A comprehensive search of bibliographic databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify relevant observational studies examining the association between hyponatremia and prognosis of HF. Data extraction, synthesis, and assessment of risk of bias were conducted. Meta-analytic methods, sensitivity analyses, and heterogeneity test were employed as appropriate to synthesize the data.

Results

A total of 43,316 patients with HF were included spanning 25 selected studies. The pooled data revealed a notable association between hyponatremia and elevated risks across short and long-term mortality of HF. Specifically, hyponatremia was found to significantly increase the likelihood of all-cause mortality (Hazard ratio [HR] = 1.94, 95% confidence interval [CI]: 1.78-2.12); 1-year mortality (HR = 1.67, 95%CI: 1.46-1.90); 30-day mortality (HR = 2.03, 95%CI: 1.73-2.25); cardiac mortality (HR = 2.11, 95%CI: 1.81-2.46); and in-hospital mortality (HR = 1.64, 95%CI: 1.15-2.34).

Conclusion

Our meta-analysis emphasizes the significant impact of hyponatremia on mortality in the HF patient population, highlighting the critical importance of maintaining stable serum sodium levels in HF management.

Risk Prediction Models and Novel Prognostic Factors for Heart Failure with Preserved Ejection Fraction: A Systematic and Comprehensive Review

BACKGROUND

Patients with heart failure with preserved ejection fraction (HFpEF) have large individual differences, unclear risk stratification, and imperfect treatment plans. Risk prediction models are helpful for the dynamic assessment of patients' prognostic risk and early intensive therapy of high-risk patients. The purpose of this study is to systematically summarize the existing risk prediction models and novel prognostic factors for HFpEF, to provide a reference for the construction of convenient and efficient HFpEF risk prediction models.

METHODS

Studies on risk prediction models and prognostic factors for HFpEF were systematically searched in relevant databases including PubMed and Embase. The retrieval time was from inception to February 1, 2023. The Quality in Prognosis Studies (QUIPS) tool was used to assess the risk of bias in included studies. The predictive value of risk prediction models for end outcomes was evaluated by sensitivity, specificity, the area under the curve, C-statistic, C-index, etc. In the literature screening process, potential novel prognostic factors with high value were explored.

RESULTS

A total of 21 eligible HFpEF risk prediction models and 22 relevant studies were included. Except for 2 studies with a high risk of bias and 2 studies with a moderate risk of bias, other studies that proposed risk prediction models had a low risk of bias overall. Potential novel prognostic factors for HFpEF were classified and described in terms of demographic characteristics (age, sex, and race), lifestyle (physical activity, body mass index, weight change, and smoking history), laboratory tests (biomarkers), physical inspection (blood pressure, electrocardiogram, imaging examination), and comorbidities.

CONCLUSION

It is of great significance to explore the potential novel prognostic factors of HFpEF and build a more convenient and efficient risk prediction model for improving the overall prognosis of patients. This review can provide a substantial reference for further research.

Clinical characteristics and 1-year outcomes in hospitalized patients with heart failure with preserved ejection fraction: results from the China Cardiovascular Association Database-Heart Failure Center Registry

AIM

We aimed to evaluate clinical characteristics and 1-year outcomes in hospitalized patients with heart failure with preserved ejection fraction (HFpEF) from China. Factors associated with outcomes (hospitalization for HF [HHF] and cardiovascular [CV] death) were assessed.

METHOD AND RESULTS

Data were from the China Cardiovascular Association (CCA) Database-HF Center Registry. Between January 2017 and June 2021, 41 708 hospitalized HFpEF patients with 1-year follow-up from 481 CCA Database-HF Center certified secondary and tertiary hospitals across overall 31 provinces of mainland China were included in this study. Of study participants (mean age 72.2 years, 49.3% female), 18.2% had HHF in prior 1 year and 55.8% had New York Heart Association class III/IV. Median left ventricular ejection fraction was 59%. Ischaemia (26.6%), infection (14.4%) and arrhythmia (10.5%) were the three most common precipitating factors for index HHF. Nearly 67.4% had ≥3 comorbidities. Hypertension (65.2%), coronary heart disease (60.3%) and atrial fibrillation (41.2%) were the three most common comorbidities. Device and medication therapy non-compliance with current HF guideline recommendation was observed. The 1-year rate of clinical outcomes was 16.4%, the 1-year rate of HHF was 13.6% and CV death was 3.1%. Factors associated with clinical outcomes included HHF in prior 1 year, serum level of sodium <135 mmol/L and N-terminal pro-B-type natriuretic peptide >1800 pg/ml.

CONCLUSION

Patients with HFpEF from China were characterized by high comorbid burden and high 1-year risk of HHF and CV death. Immediate efforts are needed to improve HFpEF management in China.

Etiology Analysis and Diagnosis and Treatment Strategy of Traumatic Brain Injury Complicated With Hyponatremia

Objective

To explore the etiology and diagnosis and treatment strategy of traumatic brain injury complicated with hyponatremia.

Methods

90 patients with traumatic brain injury admitted to our hospital from December 2019 to December 2020 were retrospectively analyzed and divided into hyponatremic group (50 patients) and non-hyponatremic group (40 patients) according to the patients' concomitant hyponatremia, and the clinical data of the two groups were collected and compared. In addition, patients in the hyponatremia group were divided into a control group and an experimental group of 25 patients each according to their order of admission, with the control group receiving conventional treatment and the experimental group using continuous renal replacement therapy (CRRT). Hemodynamic indices, mortality and serum neuron-specific enolase (NSE) indices before and after treatment were compared between the control and experimental groups. The Glasgow coma scale (GCS) was used to assess the degree of coma before and after the treatment in the two groups, and the patients' disease status was assessed using the Acute Physiological and Chronic Health Evaluation Scoring System (APACHE II).

Results

The etiology of traumatic brain injury complicated with hyponatremia is related to the degree of brain injury, ventricular hemorrhage, cerebral edema, and skull base fracture (P < 0.05). After the treatment, the hemodynamic indexes, APACHE II scores, death rate, and NSE levels of the experimental group were significantly lower than those of the control group (P < 0.001); The experimental group yielded remarkably higher GAC scores as compared to the control group (P < 0.001).

Conclusion

The degree of brain injury, ventricular hemorrhage, cerebral edema, and skull base fracture were considered to be the main factors for traumatic brain injury complicated with hyponatremia. Continuous renal replacement therapy can effectively improve the clinical indicators of the patients with a promising curative effect, which merits promotion and application.

Do we need a simplified model to predict outcomes in patients hospitalized with Acute Decompensated Heart Failure? Results from The Role of Sodium in Heart Failure Outcomes Prediction ('SHOUT-PREDICTION') study

Context

Hyponatremia is associated with high in-hospital mortality in patients with acute decompensated Heart Failure (ADHF) and is one of the components in various risk scores in heart failure (HF). However, some risk scores predict outcomes in these patients without using hyponatremia as its component.

Aim

The study was aimed to evaluate the relationship between serum sodium levels at admission and clinical outcomes during the in-hospital course and three months’ follow-up, in patients admitted in the intensive cardiac care unit (ICCU) with ADHF.

Methods and material

This was a single-center prospective, observational study in which 130 consecutive patients admitted with ADHF were observed for clinical characteristics and blood investigation at admission and their clinical outcomes during the in-hospital course and follow-up of 3 months.

Results

Hyponatremia and systolic blood pressure (SBP) both were found to be the independent predictor of in-hospital mortality. The SXS score (calculated as a product of SBP and serum sodium, divided by 1000) as a new prediction variable was significantly associated with in-hospital mortality and was compared with the Get with the guideline HF (GWTG-HF) score and ADHF national registry (ADHERE) score. The SXS score showed the best overall accuracy in predicting in-hospital mortality [area under the curve (AUC) = 0.899] as compared to the ADHERE (AUC = 0.780) and the GWTG (AUC = 0.815).

Conclusions

A score derived from the product of serum sodium and SBP (SXS score) had a significant association with in-hospital mortality, and better predictive value as compared to GWTG and ADHERE risk score in these patients.