Association between hyponatremia, mortality and hospitalization in patients with acute decompensated Heart Failure

Keywords: Heart failure, Hyponatremia, Prognosis, Mortality, Hospitalization

Abstract

Introduction. Hyponatremia is the most common electrolyte disorder in patients with chronic heart failure affecting up to 28% of patients at admission. It has been shown to be an independent predictor of mortality, extended length of hospital stay and rehospitalization. The objective is to evaluate the presence of hyponatremia in patients with decompensated heart failure and describe its relationship with length of hospital stay and mortality. Methodology. A prospective cohort study in patients hospitalized at internal medicine service at a high level of complexity hospital in Bogotá, Colombia diagnosed with decompensated heart failure  between April  2011 and March 2012. Sodium was measured on admission, 72 hours and at the seventh day of hospitalization. We evaluated the association between hyponatremia at hospital admission, mortality at 30 days and length of hospital stay. Results. 162 patients were included with an average age of 72 years, 52.5% male. Forty-one (25.3%) had hyponatremia at admission. Among the patients with normal sodium at admission, 6 had hyponatremia at 72 hours and 2 at the seventh day. In-hospital mortality in the total population was 9.2%, in the hyponatremia group 12.2%, and 8.2% in those who did not have it (p = 0.45). The average length of hospital stay was higher in patients with hyponatremia, 6.6 vs 8.4 days (p = 0.12). Discussion. The incidence of hyponatremia at admission in this group of patients was similar to that reported in the literature. Conclusions. The results showed a trend towards higher mortality and hospital stay in patients with hyponatremia, even though it was not statistically significant.

Author Biographies

Juan José Diaztagle-Fernández, Fundación Universitaria de Ciencias de la Salud

Physician, Specialist in Epidemiology, Specialist in Internal Medicine, Master in Physiology, Fundación Universitaria de Ciencias de la Salud, Universidad Nacional de Colombia, Hospital San José, Bogotá, Colombia.

Walter Gabriel Chaves-Saltiago, Fundación Universitaria de Ciencias de la Salud

Physician, Specialist in Inernal Medicine, Master in Pedagogy and Research, Fundación Universitaria de Ciencias de la Salud, Universidad Sergio Arboleda, Hospital San José, Bogotá, Colombia.

John Jaime Sprockel-Díaz, Fundación Universitaria de Ciencias de la Salud

Physician, Specialist in Internal Medicine, Master in IT and Systems Engineering, Universidad El Bosque, Pontificia Universidad Javeriana, Hospital San José, Bogotá, Colombia.

Andrés David Acevedo-Velasco, Fundación Universitaria de Ciencias de la Salud

Physician, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogotá, Colombia.

Fredy Hernán Rodríguez-Benítez, Fundación Universitaria de Ciencias de la Salud

Physician, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogotá, Colombia.

Mario Fernando Benavides-Solarte, Fundación Universitaria de Ciencias de la Salud

Physician. Fundación Universitaria de Ciencias de la Salud, Hospital San José. Bogotá, Colombia.

María Angélica Rodríguez-Niño, Fundación Universitaria de Ciencias de la Salud

Physician. Fundación Universitaria de Ciencias de la Salud. Hospital San José. Bogotá, Colombia.

Álvaro José Villamizar-Quintero, Fundación Universitaria de Ciencias de la Salud

Physician, Specialist in Internal Medicine, Fellowship in Cardiology, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogotá, Colombia.

Giovanna Botero-Jaramillo, Fundación Universitaria de Ciencias de la Salud

Physician, Specialist in Internal Medicine. Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogotá, Colombia.

Francy Liliana Plazas-Vargas

Physician, Internal Medicine Resident, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogotá, Colombia.

References

Park J, Cho Y, Oh I, Park H, Lee H, Kim K et al. Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction: An analysis of the Korean Acute Heart Failure registry. International Journal of Cardiology. 2017;248:239-245. doi: 10.1016/j.ijcard.2017.08.004

Saepudin S, Ball P, Morrissey H. Hyponatremia during hospitalization and in-hospital mortality in patients hospitalized from heart failure. BMC Cardiovascular Disorders. 2015;15(1). doi.org/10.1186/s12872-015-0082-5

Yoshioka K, Matsue Y, Kagiyama N, Yoshida K, Kume T, Okura H et al. Recovery from hyponatremia in acute phase is associated with better in-hospital mortality rate in acute heart failure syndrome. Journal of Cardiology. 2016;67(5):406-411. doi.org/10.1016/j.jjcc.2015.12.004

Verbrugge F, Grodin J, Mullens W, Taylor D, Starling R, Tang W. Transient Hyponatremia During Hospitalization for Acute Heart Failure. The American Journal of Medicine. 2016;129(6):620-627. 10.1016/j.amjmed.2016.01.016

Lu D, Cheng H, Cheng Y, Hsu P, Huang W, Guo C et al. Hyponatremia and Worsening Sodium Levels Are Associated With Long‐Term Outcome in Patients Hospitalized for Acute Heart Failure. Journal of the American Heart Association. 2016;5(3):e002668. doi: 10.1161/JAHA.115.002668.

Gudina E, Ali K, Workicho A. Hyponatremia in patients hospitalized with heart failure: a condition often overlooked in low-income settings. International Journal of General Medicine. 2016;Volume 9:267-273. doi: 10.2147/IJGM.S110872

Omar H, Charnigo R, Guglin M. Prognostic Significance of Discharge Hyponatremia in Heart Failure Patients With Normal Admission Sodium (from the ESCAPE Trial). The American Journal of Cardiology. 2017;120(4):607-615. doi: 10.1016/j.amjcard.2017.05.030

Chouihed T, Buessler A, Bassand A, et al Hyponatraemia, hyperglycaemia and worsening renal function at first blood sample on emergency department admission as predictors of in-hospital death in patients with dyspnoea with suspected acute heart failure: retrospective observational analysis of the PARADISE cohort BMJ Open 2018;(8):e019557. doi:10.1136/bmjopen-2017-019557

Leier CV, Dei Cas L, Metra M. Clinical relevance and management of the major electrolyte abnormalities in congestive heart failure: hyponatremia, hypokalemia, and hypomagnesemia. Am Heart J. 1994;128(3):564-74.

Jao GT, Chiong JR. Hyponatremia in acute decompensated heart failure: mechanisms, prognosis, and treatment options. Clin Cardiol. 2010;33(11):666-71. doi: 10.1002/clc.20822.

Patel Y, Kurgansky K, Imran T, Orkaby A, McLean R, Ho Y et al. Prognostic Significance of Baseline Serum Sodium in Heart Failure With Preserved Ejection Fraction. Journal of the American Heart Association. 2018;7(12):1-13. doi: 10.1161/JAHA.117.007529

Chatterjee K. Hyponatremia in heart failure. J Intensive Care Med. 2009;24(6):347-51. doi: 10.1177/0885066609344941

Sica DA. Sodium and water retention in heart failure and diuretic therapy: basic mechanisms. Cleve Clin J Med. 2006;73 Suppl 2:S2-7; discussion S30-3

Romanovsky A, Bagshaw S, Rosner MH. Hyponatremia and Congestive Heart Failure: A Marker of Increased Mortality and a Target for Therapy. Int J Nephrol. 2011; 2011: 732746. doi: 10.4061/2011/732746

Sica DA. Hyponatremia and heart failure--pathophysiology and implications. Congest Heart Fail. 2005;11(5):274-7. doi.org/10.1111/j.1527-5299.2005.04180.x

Lee CR, Watkins ML, Patterson JH, Gattis W, O'Connor C M, Gheorghiade M, et al. Vasopressin: a new target for the treatment of heart failure. Am Heart J. 2003;146(1):9-18. Epub 2003/07/10. DOI: 10.1016/S0002-8703(02)94708-3.

Verbrugge F, Steels P, Grieten L, Nijst P, Tang W, Mullens W. Hyponatremia in Acute Decompensated Heart Failure. Journal of the American College of Cardiology. 2015;65(5):480-492. doi.org/10.1016/j.jacc.2014.12.010

Spital A. Diuretic-induced hyponatremia. Am J Nephrol. 1999;19(4):447-52. DOI: 10.1159/000013496

Ahmed A, Husain A, Love TE, Gambassi G, Dell'Italia LJ, Francis GS, et al. Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods. Eur Heart J. 2006;27(12):1431-9. DOI: 10.1093/eurheartj/ehi890

Yamazoe M, Mizuno A, Kohsaka S, Shiraishi Y, Kohno T, Goda A et al. Incidence of hospital-acquired hyponatremia by the dose and type of diuretics among patients with acute heart failure and its association with long-term outcomes. Journal of Cardiology. 2018;71(6):550-556. DOI: 10.1016/j.jjcc.2017.09.015

Lee WH, Packer M. Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure. Circulation. 1986;73(2):257-67

Gheorghiade M, Rossi JS, Cotts W, Shin DD, Hellkamp AS, Pina IL, et al. Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE Trial. Arch Intern Med. 2007;167(18):1998-2005. DOI: 10.1001/archinte.167.18.1998

Rossi J, Bayram M, Udelson JE, Lloyd-Jones D, Adams KF, Oconnor CM, et al. Improvement in hyponatremia during hospitalization for worsening heart failure is associated with improved outcomes: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) trial. Acute Card Care. 2007;9(2):82-6. DOI: 10.1080/17482940701210179

Rusinaru D, Buiciuc O, Leborgne L, Slama M, Massy Z, Tribouilloy C. Relation of Serum Sodium Level to Long-Term Outcome After a First Hospitalization for Heart Failure with Preserved Ejection Fraction. Am J Cardiol. 2009; 103:405– 410. doi: 10.1016/j.amjcard.2008.09.091

Campo RL, Acosta RE, Gómez EA. Correlación entre los valores de sodio y el N terminal propéptido natriurético cerebral en pacientes con falla cardiaca descompensada. Rev Col Cardiol. 2012: 19(Supl 1): 39.

Gheorghiade M, Abraham WT, Albert NM, Gattis Stough W, Greenberg BH, O'Connor CM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J. 2007;28(8):980-8. DOI: 10.1093/eurheartj/ehl542

Shepshelovich D, Schechter A, Calvarysky B, Diker-Cohen T, Rozen-Zvi B, Gafter-Gvili A. Medication-induced SIADH: distribution and characterization according to medication class. British Journal of Clinical Pharmacology. 2017;83(8):1801-1807. doi: 10.1111/bcp.13256

Klein L, O'Connor CM, Leimberger JD, Gattis-Stough W, Pina IL, Felker GM, et al. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation. 2005;111(19):2454-60. DOI: 10.1161/01.CIR.0000165065.82609.3D

Nodari S, Jao G, chiong J. Clinical utility of tolvaptan in the management of hyponatremia in heart failure patients. Int J Nephrol Renovasc Dis. 2010:3 51–60. https://doi.org/10.2147/IJNRD.S7834

Tribouilloy C, Buiciuc O, Rusinaru D, Malaquin D, Lévy F, Peltier M. Long-term outcome after a first episode of heart failure. A prospective 7-year study. Int J Cardiol 2010; 140: 309-314. DOI: https://doi.org/10.1016/j.ijcard.2008.11.087

Bettari l, Fiuzat M, Shaw l, Wojdyla D, Metra M, Felker GM, O’Connor C. Hyponatremia and Long-Term Outcomes in Chronic Heart Failured: An Observational Study From the Duke Databank for Cardiovascular Diseases. J Card Fail. 2012;18: 74-81. doi: 10.1016/j.cardfail.2011.09.005

Sato N, Gheorghiade M, Kajimoto K, Munakata R, Minami Y, Mizuno M, et al. Hyponatremia and In-Hospital Mortality in Patients Admitted for Heart Failure (from the ATTEND Registry). Am J Cardiol 2013;111:1019-1025. doi: 10.1016/j.amjcard.2012.12.019

Walter C, Diaztagle J, Sprockel J, Hernández J, Benavidez J, Henao D et al . Factores asociados a mortalidad en pacientes con falla cardiaca descompensada. Acta Med Colomb 2014 ;39( 4 ): 314-320.

Shchekochikhin D, Schrier R, Lindenfeld J, Price L, Jaber B, Madias N. Outcome Differences in Community- Versus Hospital- Acquired Hyponatremia in Patients With a Diagnosis of Heart Failure. Circ Heart Fail. 2013; 6:379-386. DOI: 10.1161/CIRCHEARTFAILURE.112.000106

How to Cite
1.
Diaztagle-Fernández JJ, Chaves-Saltiago WG, Sprockel-Díaz JJ, Acevedo-Velasco AD, Rodríguez-Benítez FH, Benavides-Solarte MF, et al. Association between hyponatremia, mortality and hospitalization in patients with acute decompensated Heart Failure. MedUNAB [Internet]. 2019 Nov. 29 [cited 2026 Mar. 9];22(3):294-303. Available from: https://revistasunabeduco.biteca.online/index.php/medunab/article/view/3497

Downloads

Download data is not yet available.
Published
2019-11-29

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
Escanea para compartir
QR Code

Some similar items: