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Renal function, serum sodium level, and outcomes in hospitalized systolic heart failure patients

View Article: PubMed Central - PubMed

ABSTRACT

Both renal function and serum sodium level are well-known prognostic markers in heart failure (HF) patients. We investigated the prognostic value of the renal impairment (RI) stratified by the serum sodium level in systolic HF patients.

The Clinical Characteristics and Outcomes in Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (the COAST) Study enrolled hospitalized systolic HF patients (ejection fraction<45%) in South Korea, Taiwan, and China. Twelve-month mortality was stratified according to the renal function and serum sodium level.

Of 1462 enrolled patients, 716 patients (49%) had RI (GFR<60 mL/min/1.73 m2), and they had higher 12-month mortality than those without RI (22.8% vs. 10.9%, P<0.001). Furthermore, 676 patients (46%) had low sodium level defined as Na<median, that was, 139 mmol/L. The mortality rate was lowest in patients with normal renal function and high sodium level (7.4%), but highest in those with RI and low sodium level (26.1%) (P<0.001). Patients with both RI and low sodium level had a 3.8-times increased hazard for 12-month mortality (HR 3.80, 95% CI 2.06–7.05), whereas the low sodium level (HR, 2.95; 95% CI, 1.51–5.75) and RI (HR 3.08; 95% CI, 1.63–5.82) had similar hazard, suggesting that they might be equivalent risk factors.

In hospitalized Asian HF-patients both RI and low sodium level are independent risk factors. Patients with both RI and low serum sodium level are at the highest risk and may require meticulous medical care.

No MeSH data available.


Receiver-operating characteristics curve analysis. The best cutoff value of GFR to predict the 12-month mortality was 60 mL/min/1.73 m2 with a sensitivity, a specificity, and an area under the curve (AUC) of 0.56, 0.68, and 0.63 (95% confidence interval [CI], 0.59–0.68; P < 0.001), respectively. The best cutoff value of serum sodium level was 138 mmol/L with a sensitivity, a specificity, and an AUC of 0.67, 0.51, and 0.60 (95% CI 0.56–0.64; P < 0.001), respectively. AUC = area under the curve, CI = confidence interval, GFR = glomerular filtration rate.
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Figure 2: Receiver-operating characteristics curve analysis. The best cutoff value of GFR to predict the 12-month mortality was 60 mL/min/1.73 m2 with a sensitivity, a specificity, and an area under the curve (AUC) of 0.56, 0.68, and 0.63 (95% confidence interval [CI], 0.59–0.68; P < 0.001), respectively. The best cutoff value of serum sodium level was 138 mmol/L with a sensitivity, a specificity, and an AUC of 0.67, 0.51, and 0.60 (95% CI 0.56–0.64; P < 0.001), respectively. AUC = area under the curve, CI = confidence interval, GFR = glomerular filtration rate.

Mentions: In ROC curve analysis, the best cutoff value of GFR to predict the 12-month mortality was 60 mL/min/1.73 m2 with a sensitivity, a specificity, and an area under the curve (AUC) of 0.56, 0.68, and 0.63 (95% confidence interval [CI], 0.59–0.68; P < 0.001), respectively. As for the serum sodium level, the best cutoff value was 138 mmol/L with a sensitivity, a specificity, and an AUC of 0.67, 0.51, and 0.60 (95% CI 0.56–0.64; P < 0.001), respectively (Fig. 2).


Renal function, serum sodium level, and outcomes in hospitalized systolic heart failure patients
Receiver-operating characteristics curve analysis. The best cutoff value of GFR to predict the 12-month mortality was 60 mL/min/1.73 m2 with a sensitivity, a specificity, and an area under the curve (AUC) of 0.56, 0.68, and 0.63 (95% confidence interval [CI], 0.59–0.68; P < 0.001), respectively. The best cutoff value of serum sodium level was 138 mmol/L with a sensitivity, a specificity, and an AUC of 0.67, 0.51, and 0.60 (95% CI 0.56–0.64; P < 0.001), respectively. AUC = area under the curve, CI = confidence interval, GFR = glomerular filtration rate.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998315&req=5

Figure 2: Receiver-operating characteristics curve analysis. The best cutoff value of GFR to predict the 12-month mortality was 60 mL/min/1.73 m2 with a sensitivity, a specificity, and an area under the curve (AUC) of 0.56, 0.68, and 0.63 (95% confidence interval [CI], 0.59–0.68; P < 0.001), respectively. The best cutoff value of serum sodium level was 138 mmol/L with a sensitivity, a specificity, and an AUC of 0.67, 0.51, and 0.60 (95% CI 0.56–0.64; P < 0.001), respectively. AUC = area under the curve, CI = confidence interval, GFR = glomerular filtration rate.
Mentions: In ROC curve analysis, the best cutoff value of GFR to predict the 12-month mortality was 60 mL/min/1.73 m2 with a sensitivity, a specificity, and an area under the curve (AUC) of 0.56, 0.68, and 0.63 (95% confidence interval [CI], 0.59–0.68; P < 0.001), respectively. As for the serum sodium level, the best cutoff value was 138 mmol/L with a sensitivity, a specificity, and an AUC of 0.67, 0.51, and 0.60 (95% CI 0.56–0.64; P < 0.001), respectively (Fig. 2).

View Article: PubMed Central - PubMed

ABSTRACT

Both renal function and serum sodium level are well-known prognostic markers in heart failure (HF) patients. We investigated the prognostic value of the renal impairment (RI) stratified by the serum sodium level in systolic HF patients.

The Clinical Characteristics and Outcomes in Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (the COAST) Study enrolled hospitalized systolic HF patients (ejection fraction&lt;45%) in South Korea, Taiwan, and China. Twelve-month mortality was stratified according to the renal function and serum sodium level.

Of 1462 enrolled patients, 716 patients (49%) had RI (GFR&lt;60&#8202;mL/min/1.73 m2), and they had higher 12-month mortality than those without RI (22.8% vs. 10.9%, P&lt;0.001). Furthermore, 676 patients (46%) had low sodium level defined as Na&lt;median, that was, 139&#8202;mmol/L. The mortality rate was lowest in patients with normal renal function and high sodium level (7.4%), but highest in those with RI and low sodium level (26.1%) (P&lt;0.001). Patients with both RI and low sodium level had a 3.8-times increased hazard for 12-month mortality (HR 3.80, 95% CI 2.06&ndash;7.05), whereas the low sodium level (HR, 2.95; 95% CI, 1.51&ndash;5.75) and RI (HR 3.08; 95% CI, 1.63&ndash;5.82) had similar hazard, suggesting that they might be equivalent risk factors.

In hospitalized Asian HF-patients both RI and low sodium level are independent risk factors. Patients with both RI and low serum sodium level are at the highest risk and may require meticulous medical care.

No MeSH data available.