Hyponatremia as predictor of worse outcome in real world patients admitted with acute heart failure

Jose Carlos Arévalo Lorido, Juana Carretero Gómez, Francesc Formiga, Manuel Montero Pérez-Barquero, Joan Carles Trullás Vila, Oscar Aramburu Bodas, Luis Miguel Ceresuela, the RICA Investigators
DOI: 10.5603/CJ.2013.0136
Cardiol J 2013;20(5):506-512.

open access

Vol 20, No 5 (2013)
Original articles
Published online: 2013-10-03
Submitted: 2013-10-03
Accepted: 2013-10-03


Background: Our aim was to determine if hyponatremia, defined as serum sodium level < 135 mmol/L, is a predictor of worse outcome in a cohort of real-world patients with heartfailure (HF).

Methods: We used data of the National registry of HF (RICA) from Spain, an ongoing multicenter, prospective cohort study. The patients were assigned to two groups regarding sodium levels. Primary end-point was first all-cause readmission, or death by any cause. Secondary end-points were the number of days hospitalized, and the presence of complications.

Results: We identified 973 patients, 147 (15.11%) with hyponatremia. The median age of patients enrolled was 77.25 ± 8.79 years-old, the global comorbidity measured by Charlson comorbidity index (CCI) was upper 3 points and preserved ejection fraction was present in67.1% of them. Clinical complications during admission were significantly higher in the patients with hyponatremia (35.41%, p < 0.001) and this remained as significant predictor after logistic regression adjustment (OR 1.08, p < 0.01). Also mortality and readmissions were more frequent in patients with hyponatremia (20.69% and 22.41%, respectively) but after Cox regression adjustment hyponatremia in our cohort was not associated with increase in 90-day all-cause mortality and readmissions, and only CCI remained significant for primaryend-point (HR 1.08, p < 0.001).

Conclusions: Hyponatremia is an independent predictor of complications during hospitalization in our real-world cohort, but was not associated with 90 days mortality or readmissions. Global comorbidity, however, played an important role, and could influence the mortality and readmissions of our patients.


heart failure, hyponatremia, sodium

About this article

Hyponatremia as predictor of worse outcome in real world patients admitted with acute heart failure


Cardiology Journal


Vol 20, No 5 (2013)



Published online




Bibliographic record

Cardiol J 2013;20(5):506-512.


heart failure


Jose Carlos Arévalo Lorido
Juana Carretero Gómez
Francesc Formiga
Manuel Montero Pérez-Barquero
Joan Carles Trullás Vila
Oscar Aramburu Bodas
Luis Miguel Ceresuela
the RICA Investigators

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