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Impact of change in serum sodium concentration on mortality in patients hospitalized with heart failure and hyponatremia.
Circ Heart Fail. 2011 Sep; 4(5):637-43.CH

Abstract

BACKGROUND

Hyponatremia is a common electrolyte abnormality among patients hospitalized with heart failure and it is a marker for increased short-term and long-term mortality. However, little is known about the time course of hyponatremia and whether changes in serum sodium levels affect clinical outcomes.

METHODS AND RESULTS

Patients (n=322) hospitalized with decompensated heart failure and serum sodium <135 mmol/L were evaluated. After hospital discharge, the first sodium value obtained within a 60- to 270-day period was recorded, and patients were classified into 3 groups, based on whether the serum sodium value increased (≥2 mmol/L), decreased (≤2 mmol/L), or remained unchanged (±1 mmol/L) relative to the baseline value. Kaplan-Meier survival curves were constructed to illustrate mortality as a function of change in sodium concentration over time, and a Cox-proportional hazards model was constructed to determine if change in serum sodium concentration predicted mortality after adjusting for relevant covariates. The mean age of the population was 66 years, 45% were women, and 55% were white. The mean baseline sodium level was 131 mmol/L and the mean ejection fraction was 32.5%. Two hundred twenty-two patients (68.9%) exhibited an increase in sodium during follow-up; in 57 patients (17.7%) the level was unchanged and in 43 patients (13.4%) there was a decrease in sodium level. During a median follow-up of 610 days, there was a strong positive association between change in sodium level and survival (P for trend <0.001); that is, increased sodium was associated with decreased mortality. In multivariable analysis, change in sodium concentration and higher blood urea nitrogen were the strongest predictors of mortality (both P<0.0001).

CONCLUSIONS

Among patients hospitalized with heart failure and hyponatremia, change in serum sodium concentration over time is a strong predictor of long-term survival.

Authors+Show Affiliations

Division of Cardiology, Washington University School of Medicine, St Louis, MO 63110, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21673193

Citation

Madan, Vinay D., et al. "Impact of Change in Serum Sodium Concentration On Mortality in Patients Hospitalized With Heart Failure and Hyponatremia." Circulation. Heart Failure, vol. 4, no. 5, 2011, pp. 637-43.
Madan VD, Novak E, Rich MW. Impact of change in serum sodium concentration on mortality in patients hospitalized with heart failure and hyponatremia. Circ Heart Fail. 2011;4(5):637-43.
Madan, V. D., Novak, E., & Rich, M. W. (2011). Impact of change in serum sodium concentration on mortality in patients hospitalized with heart failure and hyponatremia. Circulation. Heart Failure, 4(5), 637-43. https://doi.org/10.1161/CIRCHEARTFAILURE.111.961011
Madan VD, Novak E, Rich MW. Impact of Change in Serum Sodium Concentration On Mortality in Patients Hospitalized With Heart Failure and Hyponatremia. Circ Heart Fail. 2011;4(5):637-43. PubMed PMID: 21673193.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of change in serum sodium concentration on mortality in patients hospitalized with heart failure and hyponatremia. AU - Madan,Vinay D, AU - Novak,Eric, AU - Rich,Michael W, Y1 - 2011/06/14/ PY - 2011/6/16/entrez PY - 2011/6/16/pubmed PY - 2011/12/14/medline SP - 637 EP - 43 JF - Circulation. Heart failure JO - Circ Heart Fail VL - 4 IS - 5 N2 - BACKGROUND: Hyponatremia is a common electrolyte abnormality among patients hospitalized with heart failure and it is a marker for increased short-term and long-term mortality. However, little is known about the time course of hyponatremia and whether changes in serum sodium levels affect clinical outcomes. METHODS AND RESULTS: Patients (n=322) hospitalized with decompensated heart failure and serum sodium <135 mmol/L were evaluated. After hospital discharge, the first sodium value obtained within a 60- to 270-day period was recorded, and patients were classified into 3 groups, based on whether the serum sodium value increased (≥2 mmol/L), decreased (≤2 mmol/L), or remained unchanged (±1 mmol/L) relative to the baseline value. Kaplan-Meier survival curves were constructed to illustrate mortality as a function of change in sodium concentration over time, and a Cox-proportional hazards model was constructed to determine if change in serum sodium concentration predicted mortality after adjusting for relevant covariates. The mean age of the population was 66 years, 45% were women, and 55% were white. The mean baseline sodium level was 131 mmol/L and the mean ejection fraction was 32.5%. Two hundred twenty-two patients (68.9%) exhibited an increase in sodium during follow-up; in 57 patients (17.7%) the level was unchanged and in 43 patients (13.4%) there was a decrease in sodium level. During a median follow-up of 610 days, there was a strong positive association between change in sodium level and survival (P for trend <0.001); that is, increased sodium was associated with decreased mortality. In multivariable analysis, change in sodium concentration and higher blood urea nitrogen were the strongest predictors of mortality (both P<0.0001). CONCLUSIONS: Among patients hospitalized with heart failure and hyponatremia, change in serum sodium concentration over time is a strong predictor of long-term survival. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/21673193/Impact_of_change_in_serum_sodium_concentration_on_mortality_in_patients_hospitalized_with_heart_failure_and_hyponatremia_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.111.961011?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -