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. 2023 Dec 22:10:1339203.
doi: 10.3389/fcvm.2023.1339203. eCollection 2023.

Association between hyponatremia and adverse clinical outcomes of heart failure: current evidence based on a systematic review and meta-analysis

Wanling Zhao #  1 , Jiangwei Qin #  1 , Guoyan Lu  1 , Yang Wang  1 , Lina Qiao  1 , Yifei Li  1
Affiliations

Association between hyponatremia and adverse clinical outcomes of heart failure: current evidence based on a systematic review and meta-analysis

Wanling Zhao et al. Front Cardiovasc Med. .

Abstract

Background: Heart failure (HF) is a global health challenge. The perturbations in fluid and electrolyte equilibrium, particularly the compromised sodium balance associated with HF lead to high mortality rates. Hence, elucidating the correlation between serum sodium levels and the prognosis of HF is of paramount importance. This study aimed to conduct a comprehensive meta-analysis to thoroughly investigate the interplay between hyponatremia and the prognostic outlook of individuals with HF.

Methods: A comprehensive search of bibliographic databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify relevant observational studies examining the association between hyponatremia and prognosis of HF. Data extraction, synthesis, and assessment of risk of bias were conducted. Meta-analytic methods, sensitivity analyses, and heterogeneity test were employed as appropriate to synthesize the data.

Results: A total of 43,316 patients with HF were included spanning 25 selected studies. The pooled data revealed a notable association between hyponatremia and elevated risks across short and long-term mortality of HF. Specifically, hyponatremia was found to significantly increase the likelihood of all-cause mortality (Hazard ratio [HR] = 1.94, 95% confidence interval [CI]: 1.78-2.12); 1-year mortality (HR = 1.67, 95%CI: 1.46-1.90); 30-day mortality (HR = 2.03, 95%CI: 1.73-2.25); cardiac mortality (HR = 2.11, 95%CI: 1.81-2.46); and in-hospital mortality (HR = 1.64, 95%CI: 1.15-2.34).

Conclusion: Our meta-analysis emphasizes the significant impact of hyponatremia on mortality in the HF patient population, highlighting the critical importance of maintaining stable serum sodium levels in HF management.

Keywords: adverse events; heart failure; hyponatremia; meta-analysis; mortality.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer YG declared a past co-authorship with the author YL to the handling editor.

Figures

Figure 1
Figure 1
The processes of database search and study selection.
Figure 2
Figure 2
Forest plot for the meta-analysis regarding the relationship between hyponatremia and all-cause mortality, 1-year mortality, 30-day mortality, cardiac mortality and in-hospital mortality risk in patients HF and hyponatremia.
Figure 3
Figure 3
Leave-one-out plot for sensitivity analysis of the relationship between hyponatremia and all-cause mortality, 1-year mortality, 30-day mortality, cardiac mortality and in-hospital mortality risk in patients HF and hyponatremia.
Figure 4
Figure 4
Meta-regression analyses based on mean age, male percentage, hypertension percentage, diabetes percentage.
Figure 5
Figure 5
Forest plot for the meta-analysis based on HF phenotype.
Figure 6
Figure 6
Funnel plot of all-cause mortality.
See this image and copyright information in PMC

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