Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.
Intern Med J. 2021 Jun;51(6):930-938. doi: 10.1111/imj.14836.
Hyponatraemia is common in patients with acute heart failure (HF).
To determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and mid-range ejection fraction (HFmrEF).
This study was a prospective multicentre consecutive registry in 20 hospitals, including patients admitted due to acute HF in cardiology departments. Sodium <135 mmol/L was considered hyponatraemia, >145 mmol/L hypernatraemia and 135-145 mmol/L normal.
A total of 1309 patients was included. Mean age was 72.0 ± 11.9 years, and 810 (61.9%) were male. Mean serum sodium level was 138.6 ± 4.7 mmol/L at hospital admission and 138.1 ± 4.1 mmol/L at discharge. The evolution of sodium levels was: normal-at-admission/normal-at-discharge 941 (71.9%), abnormal-at-admission/normal-at-discharge 127 (9.7%), normal-at-admission/abnormal-at-discharge 155 (11.8%) and abnormal-at-admission/abnormal-at-discharge 86 (6.6%). Hyponatraemia at discharge was more common in HFrEF (109 (20.7%)) than in HFpEF (79 (13.9%)) and HFmrEF (27 (12%)), P = 0.003. The prevalence of hypernatraemia at discharge was similar in the three groups: HFrEF (10 (1.9%)), HFpEF (12 (2.1%)) and HFmrEF (4 (1.9%)), P = 0.96. In multivariate analysis, abnormal sodium concentrations at hospital admission (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.15-1.76, P = 0.001) and discharge (HR 1.33, 95% CI 1.08-1.64, P = 0.007) were both independently associated with increased mortality and readmissions at 12 months.
Hyponatraemia and hypernatraemia at admission and discharge predict a poor outcome in patients with acute HF regardless of left ventricular ejection fraction. Hyponatraemia at discharge is more frequent in HFrEF than in the other groups.
低钠血症在急性心力衰竭（HF）患者中很常见。
确定钠紊乱对射血分数降低的心力衰竭（HFrEF）、射血分数保留的心力衰竭（HFpEF）和中间范围射血分数心力衰竭（HFmrEF）患者死亡率和再入院率的影响。
这是一项前瞻性多中心连续登记研究，在 20 家医院进行，包括心内科因急性 HF 入院的患者。血清钠<135mmol/L 被认为是低钠血症，>145mmol/L 是高钠血症，135-145mmol/L 是正常。
共纳入 1309 例患者。平均年龄为 72.0±11.9 岁，810 例（61.9%）为男性。入院时平均血清钠水平为 138.6±4.7mmol/L，出院时为 138.1±4.1mmol/L。钠水平的变化为：入院时正常/出院时正常 941 例（71.9%），入院时异常/出院时正常 127 例（9.7%），入院时正常/出院时异常 155 例（11.8%），入院时异常/出院时异常 86 例（6.6%）。出院时低钠血症在 HFrEF 中更为常见（109 例[20.7%]），而在 HFpEF（79 例[13.9%]）和 HFmrEF（27 例[12%]）中则不然，P=0.003。三组出院时高钠血症的发生率相似：HFrEF（10 例[1.9%]）、HFpEF（12 例[2.1%]）和 HFmrEF（4 例[1.9%]），P=0.96。多变量分析显示，入院时（危险比[HR]1.42，95%置信区间[CI]1.15-1.76，P=0.001）和出院时（HR 1.33，95%CI 1.08-1.64，P=0.007）异常的钠浓度均与 12 个月时死亡率和再入院率的增加独立相关。
入院时和出院时的低钠血症和高钠血症均预示着急性 HF 患者预后不良，与左心室射血分数无关。HFrEF 患者出院时低钠血症较其他组更为常见。
