Prognostic impact of hyponatraemia and hypernatraemia at admission and discharge in heart failure patients with preserved, mid-range and reduced ejection fraction
Por:
Vicent, L, Alvarez-Garcia, J, Gonzalez-Juanatey, JR, Rivera, M, Segovia, J, Worner, F, Bover, R, Pascual-Figal, D, Vazquez, R, Cinca, J, Fernandez-Aviles, F, Martinez-Selles, M
Publicada:
1 jun 2021
Resumen:
Background Hyponatraemia is common in patients with acute heart failure (HF). Aims: To determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and mid-range ejection fraction (HFmrEF). Methods This study was a prospective multicentre consecutive registry in 20 hospitals, including patients admitted due to acute HF in cardiology departments. Sodium <135 mmol/L was considered hyponatraemia, >145 mmol/L hypernatraemia and 135-145 mmol/L normal. Results A total of 1309 patients was included. Mean age was 72.0 +/- 11.9 years, and 810 (61.9%) were male. Mean serum sodium level was 138.6 +/- 4.7 mmol/L at hospital admission and 138.1 +/- 4.1 mmol/L at discharge. The evolution of sodium levels was: normal-at-admission/normal-at-discharge 941 (71.9%), abnormal-at-admission/normal-at-discharge 127 (9.7%), normal-at-admission/abnormal-at-discharge 155 (11.8%) and abnormal-at-admission/abnormal-at-discharge 86 (6.6%). Hyponatraemia at discharge was more common in HFrEF (109 (20.7%)) than in HFpEF (79 (13.9%)) and HFmrEF (27 (12%)), P = 0.003. The prevalence of hypernatraemia at discharge was similar in the three groups: HFrEF (10 (1.9%)), HFpEF (12 (2.1%)) and HFmrEF (4 (1.9%)), P = 0.96. In multivariate analysis, abnormal sodium concentrations at hospital admission (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.15-1.76, P = 0.001) and discharge (HR 1.33, 95% CI 1.08-1.64, P = 0.007) were both independently associated with increased mortality and readmissions at 12 months. Conclusions Hyponatraemia and hypernatraemia at admission and discharge predict a poor outcome in patients with acute HF regardless of left ventricular ejection fraction. Hyponatraemia at discharge is more frequent in HFrEF than in the other groups.
Filiaciones:
Vicent, L:
Hosp Univ 12 Octubre, Cardiol Dept, Madrid, Spain
Hosp Gen Univ Gregorio Maranon, CIBERCV, Cardiol Dept, Madrid, Spain
Alvarez-Garcia, J:
Hosp Santa Creu & Sant Pau, Cardiol Dept, CIBERCV, Barcelona, Spain
Gonzalez-Juanatey, JR:
Complexo Hosp Univ Santiago Compostela, Cardiol & Coronary Care Unit Dept, CIBERCV, La Coruna, Spain
Rivera, M:
Univ Hosp La Fe, Cardiol Dept, Valencia, Spain
Segovia, J:
Hosp Univ Puerta Hierro Majadahonda, CIBERCV, Cardiol Dept, Madrid, Spain
Worner, F:
Hosp Arnau Vilanova, IRBLLEIDA, Cardiol Dept, Lleida, Spain
Bover, R:
Hosp Clin San Carlos, Cardiol Dept, Madrid, Spain
Pascual-Figal, D:
Hosp Clin Univ Virgen Arrixaca, Cardiol Dept, El Palmar, Spain
Vazquez, R:
Puerta Mar Univ Hosp, Cardiol Dept, Cadiz, Spain
Cinca, J:
Hosp Santa Creu & Sant Pau, Cardiol Dept, CIBERCV, Barcelona, Spain
Fernandez-Aviles, F:
Hosp Gen Univ Gregorio Maranon, CIBERCV, Cardiol Dept, Madrid, Spain
Univ Complutense, Madrid, Spain
Martinez-Selles, M:
Hosp Gen Univ Gregorio Maranon, CIBERCV, Cardiol Dept, Madrid, Spain
Univ Complutense, Madrid, Spain
Univ Europea, Madrid, Spain
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