Department of Heart Diseases, Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland.
Centre for Heart Diseases, Wroclaw University Hospital, Wroclaw, Poland.
ESC Heart Fail. 2021 Aug;8(4):2597-2602. doi: 10.1002/ehf2.13372. Epub 2021 May 1.
Most studies examined spot urine sodium's (sUNa ) prognostic utility during the early phase of acute heart failure (AHF) hospitalization. In AHF, sodium excretion is related to clinical status; therefore, we investigated the differences in the prognostic information of spot UNa throughout the course of hospitalization for AHF (admission vs. discharge).
The study population were AHF patients (n = 172), who survived the index hospitalization. We compared the relationship between early (on admission, at 24 and 48 h) and discharge sUNa measurements with post-discharge study endpoints: composite of 1 year all-cause mortality and AHF rehospitalization (with time to first event analysis) as well as with each event in separation. There were 49 (28.5%) deaths, 40 (23.3%) AHF rehospitalizations, while the composite endpoint occurred in 69 (40.1%) during 1 year follow-up. The sUNa had prognostic significance for the composite endpoint when assessed on admission, at 24 and at 48 h: hazard ratios (HRs) with 95% confidence intervals (CIs) (per 10 mmol/L) were 0.88 (0.82-0.94); 0.87 (0.81-0.91); 0.90 (0.84-0.96), all P < 0.005. In contrast to early, active decongestion phase, discharge sUNa had no prognostic significance HR (95% CI) (per 10 mmol/L): 0.99 (0.93-1.06) P = 0.79 for the composite endpoint, which was independent from the dose of oral furosemide prescribed at that timepoint (average causal mediation effects: -0.38; P = 0.71). Similarly, discharge sUNa was neither associated with 1 year mortality HR (95% CI) (per 10 mmol/L): 0.97 (0.89-1.05) P = 0.48 nor with AHF rehospitalizations HR (95% CI) (per 10 mmol/l): 1.03 (0.94-1.12), P = 0.56. The comparison of longitudinal profiles of sUNa during hospitalization showed significantly higher values within the early, active decongestive phase in those who did not experience composite endpoint when compared with those who did: admission: 94 ± 34 vs. 76 ± 35; Day 1: 85 ± 36 vs. 65 ± 37; Day 2: 84 ± 37 vs. 67 ± 35, all P < 0.005 (mmol/L), respectively. There was no difference between those groups in discharge sUNa : 73 ± 35 vs. 70 ± 35 P = 0.82 (mmol/L).
Spot UNa assessed at early phase of hospitalization and at discharge have different prognostic significance, which confirms that it should be always interpreted along with clinical context.
大多数研究都考察了急性心力衰竭（AHF）住院早期阶段时的点尿钠（sUNa）的预后价值。在 AHF 中，钠排泄与临床状况有关；因此，我们研究了整个 AHF 住院期间点 UNa （入院时、出院时）的预后信息差异。
本研究人群为存活出院的 AHF 患者（n=172）。我们比较了早期（入院时、24 小时和 48 小时）和出院时 sUNa 测量值与出院后研究终点之间的关系：复合终点为 1 年全因死亡率和 AHF 再住院率（采用首次事件分析时间）以及单独事件。在 1 年的随访中，有 49 例（28.5%）死亡，40 例（23.3%）AHF 再住院，复合终点发生在 69 例（40.1%）。入院时、24 小时和 48 小时的 sUNa 对复合终点有预后意义：每增加 10mmol/L 的风险比（HR）及其 95%置信区间（CI）分别为 0.88（0.82-0.94）、0.87（0.81-0.91）和 0.90（0.84-0.96），所有 P 值均＜0.005。与早期积极的排液期相比，出院时 sUNa 无预后意义 HR（95%CI）（每增加 10mmol/L）：0.99（0.93-1.06）P 值=0.79，复合终点为独立于当时口服呋塞米的剂量（平均因果中介效应：-0.38；P=0.71）。同样，出院时 sUNa 与 1 年死亡率 HR（95%CI）（每增加 10mmol/L）也没有关系：0.97（0.89-1.05）P 值=0.48，也与 AHF 再住院率 HR（95%CI）（每增加 10mmol/L）没有关系：1.03（0.94-1.12），P 值=0.56。在住院期间 sUNa 纵向变化的比较中，与未发生复合终点的患者相比，在早期积极排液期内的 sUNa 值明显更高：入院时：94±34 比 76±35；第 1 天：85±36 比 65±37；第 2 天：84±37 比 67±35，所有 P 值均＜0.005（mmol/L）。出院时 sUNa 两组之间无差异：73±35 比 70±35 P 值=0.82（mmol/L）。
入院时和出院时点 UNa 的评估具有不同的预后意义，这证实了它应该始终与临床情况一起解释。
