The Korean journal of internal medicine

  • 제30권4호
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  • Pages.460-470
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  • 2015
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Prognostic value of hyponatremia in heart failure patients: an analysis of the Clinical Characteristics and Outcomes in the Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (COAST) study

  • Yoo, Byung-Su (Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Park, Jin Joo (Cardiovascular Center, Seoul National University Bundang Hospital) ;
  • Choi, Dong-Ju (Cardiovascular Center, Seoul National University Bundang Hospital) ;
  • Kang, Seok-Min (Department of Internal Medicine, Severance Hospital, Yonsei University Health System) ;
  • Hwang, Juey-Jen (Department of Internal Medicine, National Taiwan University Hospital) ;
  • Lin, Shing-Jong (Department of Internal Medicine, Taipei Veterans General Hospital) ;
  • Wen, Ming-Shien (Department of Internal Medicine, Chang Gung Memorial Hospital) ;
  • Zhang, Jian (Department of Internal Medicine, Fuwai Hospital) ;
  • Ge, Junbo (Department of Internal Medicine, Zhongshan Hospital) ;
  • COAST investigators (COAST)
  • 투고 : 2014.04.06
  • 심사 : 2014.09.22
  • 발행 : 2015.07.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Hyponatremia is a well-known risk factor for poor outcomes in Western studies of heart failure (HF) patients. We evaluated the predictive value of hyponatremia in hospitalized Asian HF patients. Methods: The Clinical Characteristics and Outcomes in the Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (the COAST) study enrolled hospitalized patients with systolic HF (ejection fraction < 45%) at eight centers in South Korea, Taiwan, and China. The relationship between admission sodium level and clinical outcomes was analyzed in 1,470 patients. Results: The mean admission sodium level was $138{\pm}4.7mmol/L$, and 247 patients (16.8%) had hyponatremia defined as $Na^+$ < 135 mmol/L. The 12-month mortality was higher in hyponatremic patients (27.9% vs. 14.6%, p < 0.001), and hyponatremia was an independent predictor of 12-month mortality (hazard ratio, 1.72; 95% confidence interval, 1.12 to 2.65). During hospital admission, 57% of hyponatremic patients showed improvement without improvement in their clinical outcomes (p = 0.620). The proportion of patients with optimal medical treatment was only 26.5% and 44.2% at admission and discharge, respectively, defined as the combined use of angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker and ${\beta}-blocker$. Underuse of optimal medical treatment was more pronounced in hyponatremic patients. Conclusions: In hospitalized Asian HF patients, hyponatremia at admission is common and is an independent predictor of poor clinical outcome. Furthermore, hyponatremic patients receive less optimal medical treatment than their counterparts.

키워드

참고문헌

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