title: Hyponatremia and Worsening Sodium Levels Are Associated With Long-Term Outcome in Patients Hospitalized for Acute Heart Failure.
abstract: BACKGROUND
  Hyponatremia predicts poor prognosis in patients with acute heart failure (AHF). However, the association of the severity of hyponatremia and changes of serum sodium levels with long-term outcome has not been delineated.
  
  
  RESULTS
  The study population was drawn from the HARVEST registry (Heart Failure Registry of Taipei Veterans General Hospital), so that patients hospitalized for acute heart failure (AHF) composed this study. The National Death Registry was linked to identify the clinical outcomes of all-cause mortality and cardiovascular death, with a follow-up duration of up to 4 years. Among a total of 2556 patients (76.4 years of age, 67% men), 360 had on-admission hyponatremia, defined as a serum sodium level of <135 mEq/L on the first day of hospitalization. On-admission hyponatremia was a predictor for all-cause mortality (hazard ratio and 95% CI: 1.43, 1.11-1.83) and cardiovascular mortality (1.50, 1.04-2.17), independent of age, sex, hematocrit, estimated glomerular filtration rate, left ventricular ejection fraction, and prescribed medications. Subjects with severe hyponatremia (<125 mEq/L) would even have worse clinical outcomes. During hospitalization, a drop of sodium levels of >3 mEq/L was associated with a marked increase of mortality than those with minimal or no drop of sodium levels. In addition, subjects with on-admission hyponatremia and drops of serum sodium levels during hospitalization had an incremental risk of death (2.26, 1.36-3.74), relative to those with normonatremia at admission and no treatment-related drop of serum sodium level in the fully adjusted model.
  
  
  CONCLUSIONS
  On-admission hyponatremia is an independent predictor for long-term outcomes in patients hospitalized for AHF. Combined the on-admission hyponatremia with drops of serum sodium levels during hospitalization may make a better risk assessment in AHF patients.
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Dai-Yin
authors.initials: DY
authors.lastname: Lu
authors.affiliation: Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hao-Min
authors.initials: HM
authors.lastname: Cheng
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yu-Lun
authors.initials: YL
authors.lastname: Cheng
authors.affiliation: Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Pai-Feng
authors.initials: PF
authors.lastname: Hsu
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Huang
authors.affiliation: Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Guo
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wen-Chung
authors.initials: WC
authors.lastname: Yu
authors.affiliation: Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chen-Huan
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Public Health, National Yang-Ming University, Taipei, Taiwan mr.sungsh@gmail.com.
authors.forename: Shih-Hsien
authors.initials: SH
authors.lastname: Sung
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015536:Down-Regulation; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D007010:Hyponatremia / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*; D013624:Taiwan; D013997:Time Factors
chemical_list: D015415:Biomarkers; D012964:Sodium
keywords: acute heart failure; hyponatremia; mortality