الفهرس 
The value of urinary sodium excretion in predicting adverse outcome after heart failure hospitalization
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Abstract
Background: Acute decompensated heart failure (ADHF) is a frequent medical
condition that needs immediate evaluation and appropriate treatment. Relief of
congestion is the primary goal of initial therapy for patients with signs and symptoms
of volume overload. Some patients may develop diuretic resistance, resulting in
insufficient and delayed decongestion, with increased mortality and morbidity.Early
measurement of urine sodium concentration (UNa) has been proposed as a useful
parameter to tailor diuretic therapy in these patients.
Objectives: The aim of this study was to determine the value of first spot UNa after
diuretic initiation to predict a composite of primary endpoints that included inhospital death and death or re-hospitalization within 90 days after hospital discharge.
Patients and methods: At the time of admission, 100 patients with ADHF were
identified prospectively, and UNa was measured after the first dose of intravenous
diuretic. Clinical outcomes were compared for patients with UNa 60 mmol/L and
UNa of ≤60 mmol/L, with the primary outcome of a composite of death at the
hospital and 90 days, mechanical circulatory support during admission, length of
hospital stay (LOS), and hospital re-admission within 90 days of discharge.
Results: Patients with low early UNa had a longer length of stay (8 vs 4 days, P <
0.001) than patients with UNa >60 mmol/L. Worsening renal function was
significantly more common in patients with UNa ≤60 mmol/L (100%, P < 0.001).
In-hospital mortality and mortality at 90 days were higher among patients with
UNa≤60 (70.8%, P<0.001 and 50%, P 0.007 respectively). Patients with low UNa
early after the first inpatient diuretic dose had a higher risk of in-hospital and 90 days
mortality (RR 15.83 with 95% CI 7.91-31.67; P <0.007)