Abstract 14815: Progressive Hyponatremia during Heart Failure Treatment Provides Additional Long-Term Prognostic Information to Hyponatremia and Hypoalbuminemia in Patients Admitted with Acute Decompensated Heart Failure
Backgrounds: Although hyponatremia and hypoalbuminemia have been shown to be predictors of adverse outcome in patients (pts) admitted with decompensated heart failure (ADHF), there is little information available on the long-term prognostic significance of the progression of these parameters in pts with survival discharge from ADHF.
Methods and Results: We studied 305 consecutive pts admitted with ADHF and discharged with survival. The measurements of the serum levels of sodium and albumin were repeated during the treatment of congestion, and the maximum depression of serum sodium and albumin levels in comparison to the value at admission were obtained. During a mean follow-up period of 4.4±3.3 (0-13) yrs, 72 pts had cardiovascular death (CVD). At multivariate Cox analysis, serum sodium level at admission (p<0.0001), albumin level at discharge (p=0.0006) and the maximum depression of serum sodium level after the admission (p<0.0001) were independently associated with CVD, although the maximum depression of albumin level after the admission (p=0.0004) showed significant association with CVD at univariate analysis. In group with hyponatremia (hypoNa:≤135mEq/L) or hypoalbuminemia (hypoAlb:≤3.4mg/dl), CVD was significantly frequently observed in pts with than without progressive hypoNa (66% vs 25%, p<0.0001), which was defined as higher degree of the maximum depression of serum sodium level after the admission (≥8mEq/L: the 25 percentile value), and the adjusted hazard ratio of progressive hypoNa for CVD was 2.9 (95%CI 1.6-5.5, p=0.0008). Furthermore, in group without hypoNa or hypoAlb, progressive hypoNa also had significantly higher risk of CVD (33% vs 9%, p<0.0001, adjusted hazard ratio: 4.1 (95%CI 1.9-9.0), p=0.0014).
Conclusion: Progressive hyponatremia during heart failure treatment could provide the additional long-term prognostic information to hyponatremia and hypoalbuminemia in pts admitted with ADHF.
- © 2012 by American Heart Association, Inc.