Abstract 16935: Hyponatremia in Children Hospitalized with Decompensated Heart Failure: Prevalence, Severity and Association with Clinical Outcome
Introduction: Hyponatremia occurs commonly in adults with heart failure (HF) but its prevalence, severity and clinical impact are not known in children.
Hypothesis: Hyponatremia is associated with adverse clinical outcomes in children hospitalized with HF.
Methods: Consecutive patients (pts) from a single institution who required hospitalization for treatment of acute decompensated heart failure were studied. Inclusion criteria: pts age 3 months to 21 years hospitalized for HF attributable to ventricular dysfunction. Exclusion criteria: acute graft rejection, disease of the central nervous system, HF attributable to left-to-right intracardiac shunts, cyanotic heart disease, treatment with vasopressin during hospitalization. Admission serum sodium (Na) concentration and lowest Na before the composite end-point or discharge were examined. The composite end-point was death, transplant or use of mechanical circulatory support.
Results: One hundred forty-one patients met study criteria. Etiologies of HF included: dilated cardiomyopathy (n=89, 63%), acute myocarditis (n=27, 19%), ischemic cardiomyopathy (n=17, 12%), restrictive cardiomyopathy (n=5, 4%), hypertrophic cardiomyopathy (n=5, 4%). The cohort included 48 (34%) pts with pre-existing HF. Mean serum Na at admission was 137 ±4 mmol/L. Hyponatremia (serum Na <135 mmol/L) was present in 45 (32%) pts at admission. Hyponatremia subsequently developed in 72 (51%) pts during their hospitalization and dropped below 130 mmol/L in 50 (35%) pts. The composite end-point occurred in 58 (41%) pts. Those pts who were hyponatremic at admission were more likely to reach the composite end-point than pts who had normal or high Na concentrations at admission (26/45 pts [58%] vs 32/96 [33%], p=0.006). Among pts who met the composite end-point, the mean lowest serum Na concentration was 128 (±4) mmol/L. Hyponatremia at admission was independently associated with death, transplant or the use of mechanical circulatory support during hospitalization (OR 3.1, p=0.003).
Conclusions: Hyponatremia occurs commonly in children hospitalized with acute decompensated HF and is associated with in-hospital mortality, transplant and the need for mechanical circulatory support.
Author Disclosures: J. Price: None. K. Chiou: None. J. Hanna: None. J. Goldberg: None. T. Humlicek: None. J. Hagan: None. A. Cabrera: None. A. Jeewa: None. S. Denfield: None. W. Dreyer: None. A. Arikan: None.
- © 2014 by American Heart Association, Inc.