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Observational Study
. 2018 Mar 30;8(3):e019557.
doi: 10.1136/bmjopen-2017-019557.

Hyponatraemia, hyperglycaemia and worsening renal function at first blood sample on emergency department admission as predictors of in-hospital death in patients with dyspnoea with suspected acute heart failure: retrospective observational analysis of the PARADISE cohort

Tahar Chouihed  1   2   3 , Aurélien Buessler  1 , Adrien Bassand  1   2 , Deborah Jaeger  1   2 , Jean Marc Virion  4   5 , Lionel Nace  6 , Françoise Barbé  7 , Sylvain Salignac  8 , Patrick Rossignol  2   3   9 , Faiez Zannad  2   3   9 , Nicolas Girerd  2   3   9
Affiliations
Observational Study

Hyponatraemia, hyperglycaemia and worsening renal function at first blood sample on emergency department admission as predictors of in-hospital death in patients with dyspnoea with suspected acute heart failure: retrospective observational analysis of the PARADISE cohort

Tahar Chouihed et al. BMJ Open. .

Abstract

Objectives: To assess the prognostic value of hyponatraemia, hyperglycaemia and impaired estimated glomerular filtration rate (eGFR) in predicting in-hospital death in patients with acute heart failure (AHF) admitted for acute dyspnoea in the emergency department.

Design: Retrospective observational study.

Setting: Emergency Department of the University Hospital of Nancy. Data were collected from August 2013 to October 2015.

Participants: The analysis included 405 patients with AHF admitted for acute dyspnoea in an emergency department.

Results: The population was elderly (mean age 82 years), 20.1% had hyponatraemia, 45.1% had hyperglycaemia and 48.6% had eGFR <50 mL/min/1.73 m2. Sixty-one patients (15.1%) died in hospital, mostly due to cardiac aetiology (58.3%). In multivariable analysis adjusted for key potential confounders, adjusted hyponatraemia (OR=2.40, (1.16 to 4.98), p=0.02), hyperglycaemia (OR=2.00, 1.06 to 3.76, p=0.03) and eGFR <50 mL/min/1.73 m2 (OR=1.97 (1.00 to 3.80), p=0.04*) were all identified as significant independent predictors of in-hospital death.

Conclusions: Results of basic routine laboratory tests (hyponatraemia, hyperglycaemia and impaired eGFR) performed on admission in the emergency department are independently associated with in-hospital death. These inexpensive tests, performed as early as patient admission in the emergency department, could allow the early identification of patients admitted for AHF who are at high risk of in-hospital death.

Trial registration number: NCT02800122.

Keywords: acute heart failure; basic laboratory test parameters; emergency department; mortality predictors.

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Conflict of interest statement

Competing interests: TC and NG have received Board Membership Fees from Novartis. PR received fees from Relypsa. FZ has received fees for serving on the board of Boston Scientific; consulting fees from Novartis, Takeda, AstraZeneca, Boehringer Ingelheim, GE Healthcare, Relypsa, Servier, Boston Scientific, Bayer, Johnson and Johnson, and Resmed; and speakers’ fees from Pfizer and AstraZeneca. FZ and PR are co-founders of CardioRenal diagnostics.

Figures

Figure 1
Figure 1
Flow chart. AHF, acute heart failure.
See this image and copyright information in PMC

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