University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Heart Fail. 2020 Aug;22(8):1438-1447. doi: 10.1002/ejhf.1753. Epub 2020 Feb 22.
Urinary sodium assessment has recently been proposed as a target for loop diuretic therapy in acute heart failure (AHF). We aimed to investigate the time course, clinical correlates and prognostic importance of urinary sodium excretion in AHF.
In a prospective cohort of 175 consecutive patients with an admission for AHF we evaluated urinary sodium excretion 6 h after initiation of loop diuretic therapy. Clinical outcome was all-cause mortality or heart failure rehospitalization. Mean age was 71 ± 14 years, and 44% were female. Median urinary sodium excretion was 130 (67-229) mmol at 6 h, 347 (211-526) mmol at 24 h, and decreased from day 2 to day 4. Lower urinary sodium excretion was independently associated with male gender, younger age, renal dysfunction and pre-admission loop diuretic use. There was a strong association between urinary sodium excretion at 6 h and 24 h urine volume (beta = 0.702, P < 0.001). Urinary sodium excretion after 6 h was a strong predictor of all-cause mortality after a median follow-up of 257 days (hazard ratio 3.81, 95% confidence interval 1.92-7.57; P < 0.001 for the lowest vs. the highest tertile of urinary sodium excretion) independent of established risk factors and urinary volume. Urinary sodium excretion was not associated with heart failure rehospitalization.
In a modern, unselected, contemporary AHF population, low urinary sodium excretion during the first 6 h after initiation of loop diuretic therapy is associated with lower urine output in the first day and independently associated with all-cause mortality.
最近有研究提出，尿钠评估可作为急性心力衰竭（AHF）中袢利尿剂治疗的目标。本研究旨在探讨 AHF 患者中，袢利尿剂治疗开始后 6 小时尿钠排泄的时间过程、临床相关性和预后意义。
本前瞻性队列研究纳入了 175 例因 AHF 入院的连续患者，在开始袢利尿剂治疗后 6 小时评估尿钠排泄。临床终点为全因死亡率或心力衰竭再住院。患者平均年龄为 71±14 岁，44%为女性。6 小时时尿钠排泄中位数为 130（67-229）mmol，24 小时时为 347（211-526）mmol，并在第 2 天至第 4 天逐渐下降。较低的尿钠排泄与男性、年龄较小、肾功能不全和入院前使用袢利尿剂独立相关。6 小时尿钠排泄与 24 小时尿量之间存在很强的相关性（β=0.702，P<0.001）。6 小时尿钠排泄是中位随访 257 天后全因死亡率的强烈预测因子（危险比 3.81，95%置信区间 1.92-7.57；最低与最高三分位尿钠排泄组相比，P<0.001），独立于既定的危险因素和尿量。尿钠排泄与心力衰竭再住院无关。
在现代、未选择、当代 AHF 人群中，袢利尿剂治疗开始后 6 小时内尿钠排泄较低与第 1 天尿量减少有关，且与全因死亡率独立相关。
