Department of Cardiology, The Prince Charles Hospital, 627 Rode Rd, Queensland QLD 4032, Australia.
School of Clinical Medicine, The University of Queensland, Queensland QLD 4072, Australia.
Eur Heart J Qual Care Clin Outcomes. 2022 Oct 26;8(7):709-721. doi: 10.1093/ehjqcco/qcac007.
Urinary sodium concentration (UNa) is a simple test advocated to assess diuretics efficacy and predict outcomes in acute heart failure (AHF). We performed a systematic review and meta-analysis to examine the association of UNa with outcomes of AHF.
We searched Embase and Medline for eligible studies that reported the association between UNa and outcomes of urinary output, weight loss, worsening renal function, length of hospital stay, re-hospitalization, worsening heart failure, and all-cause mortality in AHF. Nineteen observational studies out of 1592 screened records were included. For meta-analyses of outcomes, we grouped patients into high vs. low UNa, with most studies defining high UNa as >48-65 mmol/L. In the high UNa group, pooled data showed a higher urinary output (mean difference 502 mL, 95% CI 323-681, P < 0.01), greater weight loss (mean difference 1.6 kg, 95% CI 0.3-2.9, P = 0.01), and a shorter length of stay (mean difference -1.4 days, 95% CI -2.8 to -0.1, P = 0.03). There was no significant difference in worsening kidney function (OR 0.54, 95% CI 0.25-1.16, P = 0.1). Due to the small number of studies, we did not report pooled estimates for re-hospitalization and worsening heart failure. High UNa was associated with lower odds of 30-day (OR 0.27; 95% CI 0.14-0.49, P < 0.01), 90-day (OR 0.39,95% CI 0.25-0.59, P < 0.01) and 12-month (OR 0.35; 95% CI 0.20-0.61, P < 0.01) mortality.
High UNa after diuretic administration is associated with higher urinary output, greater weight loss, shorter length of stay, and lower odds of death. UNa is a promising marker of diuretic efficacy in AHF which should be confirmed in randomized trials.
尿钠浓度（UNa）是一种简单的测试，可以用来评估利尿剂的疗效，并预测急性心力衰竭（AHF）的结果。我们进行了一项系统评价和荟萃分析，以检查 UNa 与 AHF 结局之间的关系。
我们在 Embase 和 Medline 上搜索了报告 UNa 与尿输出量、体重减轻、肾功能恶化、住院时间、再住院、心力衰竭恶化和全因死亡率之间关系的合格研究。在筛选出的 1592 份记录中，有 19 项观察性研究入选。对于结局的荟萃分析，我们将患者分为高 UNa 与低 UNa，大多数研究将高 UNa 定义为 >48-65mmol/L。在高 UNa 组中，汇总数据显示尿输出量更高（平均差异 502ml，95%CI 323-681，P <0.01），体重减轻更多（平均差异 1.6kg，95%CI 0.3-2.9，P=0.01），住院时间更短（平均差异-1.4 天，95%CI-2.8 至-0.1，P=0.03）。肾功能恶化的差异无统计学意义（OR 0.54，95%CI 0.25-1.16，P=0.1）。由于研究数量较少，我们未报告再住院和心力衰竭恶化的汇总估计值。高 UNa 与 30 天（OR 0.27；95%CI 0.14-0.49，P <0.01）、90 天（OR 0.39，95%CI 0.25-0.59，P <0.01）和 12 个月（OR 0.35；95%CI 0.20-0.61，P <0.01）死亡率的可能性降低相关。
利尿剂治疗后高 UNa 与更高的尿输出量、更大的体重减轻、更短的住院时间和更低的死亡率相关。UNa 是 AHF 中利尿剂疗效的有前途的标志物，应在随机试验中得到证实。
