Hyponatremia as predictor of worse outcome in real world patients admitted with acute heart failure.
BACKGROUND
Our aim was to determine if hyponatremia, defined as serum sodium level < 135 mmol/L, is a predictor of worse outcome in a cohort of real-world patients with heartfailure (HF).


METHODS
We used data of the National registry of HF (RICA) from Spain, an ongoing multicenter, prospective cohort study. The patients were assigned to two groups regarding sodium levels. Primary end-point was first all-cause readmission, or death by any cause. Secondary end-points were the number of days hospitalized, and the presence of complications.


RESULTS
We identified 973 patients, 147 (15.11%) with hyponatremia. The median age of patients enrolled was 77.25 ± 8.79 years-old, the global comorbidity measured by Charlson comorbidity index (CCI) was upper 3 points and preserved ejection fraction was present in67.1% of them. Clinical complications during admission were significantly higher in the patients with hyponatremia (35.41%, p < 0.001) and this remained as significant predictor after logistic regression adjustment (OR 1.08, p < 0.01). Also mortality and readmissions were more frequent in patients with hyponatremia (20.69% and 22.41%, respectively) but after Cox regression adjustment hyponatremia in our cohort was not associated with increase in 90-day all-cause mortality and readmissions, and only CCI remained significant for primaryend-point (HR 1.08, p < 0.001).


CONCLUSIONS
Hyponatremia is an independent predictor of complications during hospitalization in our real-world cohort, but was not associated with 90 days mortality or readmissions. Global comorbidity, however, played an important role, and could influence the mortality and readmissions of our patients.
Internal Medicine Service, Hospital de Zafra, Zafra, Badajoz, Spain. joscarlor@gmail.com.
Jose Carlos
JC
Arévalo Lorido
Juana
J
Carretero Gómez
Francesc
F
Formiga
Manuel
M
Montero Pérez-Barquero
Joan Carles
JC
Trullás Vila
Oscar
O
Aramburu Bodas
Luis Miguel
LM
Ceresuela
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012964:Sodium / Q000097:blood; D013030:Spain; D013997:Time Factors
D015415:Biomarkers; D012964:Sodium