title: Incidence, Severity, and Association With Adverse Outcome of Hyponatremia in Children Hospitalized With Heart Failure.
abstract: Hyponatremia is a common finding in adults hospitalized with heart failure (HF) and is associated with longer hospital stays and increased mortality. The significance of hyponatremia in children with HF is not known. We sought to determine the incidence of hyponatremia and association with clinical outcome in children hospitalized with HF. Admission and inpatient serum sodium concentrations were analyzed in 141 consecutive children hospitalized with acute decompensated HF. Inclusion criteria include patients (age, birth to 21 years) with biventricular hearts who were hospitalized for HF from January 2007 to December 2012. The primary composite end point was death, cardiac transplantation, or the use of mechanical circulatory support (MCS) during hospitalization. Data for 141 patients were included in the analysis. The cohort included 48 patients (34%) with preexisting HF. Mean serum sodium at admission was 136 ± 4 mmol/L (range 124 to 150 mmol/L). Hyponatremia (serum sodium <135 mmol/L) was present in 45 patients (32%) at admission. Seventy-one patients (75%) with normal serum sodium concentrations at admission subsequently developed acquired hyponatremia during their hospitalization. Hyponatremia persisted at discharge in 17 of 66 patients (26%). Fifty-eight patients (41%) reached the composite end point during hospitalization (death, n = 15; cardiac transplantation, n = 27; MCS, n = 46). Hyponatremia at admission was independently associated with death, cardiac transplantation, or the use of MCS during hospitalization (odds ratio 3.1, p = 0.02). In conclusion, hyponatremia occurs commonly in children hospitalized with acute decompensated HF and is associated with increased risk of in-hospital mortality, cardiac transplantation, and need for MCS.
authors.affiliation: Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. Electronic address: jprice@bcm.tmc.edu.
authors.forename: Jack F
authors.initials: JF
authors.lastname: Price
authors.affiliation: Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Kantor
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Shaddy
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
authors.affiliation: Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Jason F
authors.initials: JF
authors.lastname: Goldberg
authors.affiliation: Office of Research, Texas Children's Hospital, Houston, Texas.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hagan
authors.affiliation: Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Humlicek
authors.affiliation: Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Cabrera
authors.affiliation: Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Aamir
authors.initials: A
authors.lastname: Jeewa
authors.affiliation: Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Denfield
authors.affiliation: Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: William J
authors.initials: WJ
authors.lastname: Dreyer
authors.affiliation: Department of Pediatrics, Section of Pediatric Nephrology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Ayse
authors.initials: A
authors.lastname: Akcan-Arikan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009026:Mortality; D016017:Odds Ratio; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013781:Texas / Q000453:epidemiology; D055815:Young Adult