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Sodium levels during hospitalization with acute myocardial infarction are markers of in-hospital mortality: Soroka acute myocardial infarction II (SAMI-II) project

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Abstract

Objective

Abnormalities in sodium homeostasis are common in hospitalized patients. Hyponatremia upon admission is a poor prognostic marker in acute myocardial infarction (AMI) patients. However, little is known about the association between changes in sodium levels and in-hospital mortality. We delineated changes in sodium levels and studied the association of such changes with in-hospital mortality of AMI patients.

Methods

Retrospective analysis of AMI patients hospitalized for > 6 days. Sodium levels throughout the 6-day post-admission were divided into five equally sized groups (quintiles = Q) and thereafter categorized as follows: Q1 (< 135 mEq/L), Q2–Q4 (135–140 mEq/L, reference group), and Q5 (≥141 mEq/L). Primary outcome: in-hospital mortality.

Results

A total of 8306 patients (10,416 admissions) were included (mean age 67.8 ± 14.0 years, 33.4% women, 45.5% STEMI). In-hospital mortality was 6.6%. Q1 and Q5 upon admission were both related to higher risk for in-hospital mortality, compared with the reference group (OR 1.47 and OR 1.33, respectively, p < 0.001 each). Q1 was more frequent in non-survivors throughout the entire study period, while the prevalence of Q5 levels was similar in survivors and non-survivors upon admission carrying increasing mortality risk thereafter: for Q1 consistent OR 1.50, while for Q5 it, increased from OR 1.32 upon admission to OR 1.90 on the sixth day, p < 0.001.

Conclusions

Low and high sodium levels are associated with increased risk for in-hospital mortality in patients with AMI. The risk is unchanged for hyponatremia, while it consistently increases for increased sodium levels.

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References

  1. Adrogue HJ, Madias NE (2000) Hyponatremia. N Engl J Med 42:1581–1589

    Article  Google Scholar 

  2. Dargie HJ, Cleland JG, Leckie BJ, Inglis CG, East BW, Ford I (1987) Relation of arrhythmias and electrolyte abnormalities to survival in patients with severe chronic heart failure. Circulation 75:IV98–107

    CAS  PubMed  Google Scholar 

  3. Hoorn EJ, Zietse R (2013) Hyponatremia and mortality: moving beyond associations. Am J Kidney Dis 62:139–149

    Article  CAS  Google Scholar 

  4. Akirov A, Diker-Cohen T, Steinmetz T, Amitai O, Shimon I (2017) Sodium levels on admission are associated with mortality risk in hospitalized patients. Eur J Intern Med S0953-6205(17):30285–30286

    Google Scholar 

  5. Goldberg A, Hammerman H, Petcherski S, Nassar M, Zdorovyak A, Yalonetsky S, Kapeliovich M, Agmon Y, Beyar R, Markiewicz W et al (2006) Hyponatremia and long-term mortality in survivors of acute ST-elevation myocardial infarction. Arch Intern Med 166:781–786

    Article  Google Scholar 

  6. Goldberg A, Hammerman H, Petcherski S, Zdorovyak A, Yalonetsky S, Kapeliovich M, Agmon Y, Markiewicz W, Aronson D (2004) Prognostic importance of hyponatremia in acute ST-elevation myocardial infarction. Am J Med 117:242–248

    Article  CAS  Google Scholar 

  7. Singla I, Zahid M, Good CB, Macioce A, Sonel AF (2011) Effect of hyponatremia (< 135 mEq/L) on outcome in patients with non-ST-elevation acute coronary syndrome. Am J Cardiol 100:406–408

    Article  Google Scholar 

  8. Havranek S, Belohlavek J, Skulec R, Kovarnik T, Dytrych V, Linhart A (2011) Long-term prognostic impact of hyponatremia in the ST-elevation myocardial infarction. Scand J Clin Lab Invest 71:38–44

    Article  CAS  Google Scholar 

  9. Klopotowski M, Kruk M, Przyluski J, Kalinczuk L, Pregowski J, Bekta P, Malek LA, Kepka C, Ciszewski A, Chmielak Z et al (2009) Sodium level on admission and in-hospital outcomes of STEMI patients treated with primary angioplasty: the ANIN myocardial infarction registry. Med Sci Monit 15:CR477–483

    CAS  PubMed  Google Scholar 

  10. Tada Y, Nakamura T, Funayama H, Sugawara Y, Ako J, Ishikawa SE, Momomura S (2011) Early development of hyponatremia implicates short- and long-term outcomes in ST-elevation acute myocardial infarction. Circ J 75:1927–1933

    Article  CAS  Google Scholar 

  11. Tang Q, Hua Q (2011) Relationship between hyponatremia and in-hospital outcomes in Chinese patients with ST-elevation myocardial infarction. Intern Med 50:969–974

    Article  Google Scholar 

  12. Bae MH, Kim JH, Jang SY, Park SH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC (2017) Hyponatremia at discharge as a predictor of 12-month clinical outcomes in hospital survivors after acute myocardial infarction. Heart Vessels 32:126–133

    Article  Google Scholar 

  13. Plakht Y, Shiyovich A, Weitzman S, Fraser D, Zahger D, Gilutz H (2012) A new risk score predicting 1- and 5-year mortality following acute myocardial infarction Soroka acute myocardial infarction (SAMI) project. Int J Cardiol 154:173–179

    Article  Google Scholar 

  14. Qureshi W, Hassan S, Khalid F, Almahmoud MF, Shah B, Tashman R, Ambulgekar N, El-Refai M, Mittal C, Alirhayim Z (2013) Outcomes of correcting hyponatremia in patients with myocardial infarction. Clin Res Cardiol 102:637–644

    Article  Google Scholar 

  15. Wannamethee SG, Shaper AG, Lennon L, Papacosta O, Whincup P (2016) Mild hyponatremia, hypernatremia and incident cardiovascular disease and mortality in older men: a population-based cohort study. NMCD 26:12–19

    CAS  PubMed  Google Scholar 

  16. Tatlisu MA, Kaya A, Keskin M, Uzman O, Borklu EB, Cinier G, Hayiroglu MI, Tatlisu K, Eren M (2017) Can we use plasma hyperosmolality as a predictor of mortality for ST-segment elevation myocardial infarction? Coron Artery Dis 28:70–76

    Article  Google Scholar 

  17. Plakht Y, Gilutz H, Shiyovich A (2016) Temporal trends in acute myocardial infarction: What about survival of hospital survivors? Disparities between STEMI & NSTEMI remain. Soroka acute myocardial infarction II (SAMI-II) project. Int J Cardiol 203:1073–1081

    Article  Google Scholar 

  18. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF III, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  Google Scholar 

  19. Movafagh S, Cleemann L, Morad M (2011) Regulation of cardiac Ca(2+) channel by extracellular Na(+). Cell Calcium 49:162–173

    Article  CAS  Google Scholar 

  20. Mouallem M, Friedman E, Shemesh Y, Mayan H, Pauzner R, Farfel Z (1991) Cardiac conduction defects associated with hyponatremia. Clin Cardiol 14:165–168

    Article  CAS  Google Scholar 

  21. Wali MV, Yatiraj S (2014) Study of serum sodium and potassium in acute myocardial infarction. JCDR 8:CC07-09

    Google Scholar 

  22. Brown MJ, Brown DC, Murphy MB (1983) Hypokalemia from beta2-receptor stimulation by circulating epinephrine. N Engl J Med 309:1414–1419

    Article  CAS  Google Scholar 

  23. Shiyovich A, Gilutz H, Plakht Y (2014) Serum potassium levels and long-term post-discharge mortality in acute myocardial infarction. Int J Cardiol 172:e368-370

    Article  Google Scholar 

  24. Schaller MD, Nussberger J, Feihl F, Waeber B, Brunner HR, Perret C, Nicod P (1987) Clinical and hemodynamic correlates of elevated plasma arginine vasopressin after acute myocardial infarction. Am J Cardiol 60:1178–1180

    Article  CAS  Google Scholar 

  25. Abdin A, Pöss J, Fuernau G, Ouarrak T, Desch S, Eitel I, de Waha S, Zeymer U, Böhm M, Thiele H (2018) Revision: prognostic impact of baseline glucose levels in acute myocardial infarction complicated by cardiogenic shock-a substudy of the IABP-SHOCK II-trial. Clin Res Cardiol. https://doi.org/10.1007/s00392-018-1213-7

    Article  CAS  Google Scholar 

  26. Sigurdsson A, Held P, Swedberg K (1993) Short- and long-term neurohormonal activation following acute myocardial infarction. Am Heart J 126:1068–1076

    Article  CAS  Google Scholar 

  27. Schrier RW, Abraham WT (1999) Hormones and hemodynamics in heart failure. N Engl J Med 341:577–585

    Article  CAS  Google Scholar 

  28. Afzali D, Erren M, Pavenstädt HJ, Vollert JO, Hertel S, Waltenberger J, Reinecke H, Lebiedz P (2013 Oct) Impact of copeptin on diagnosis, risk stratification, and intermediate-term prognosis of acute coronary syndromes. Clin Res Cardiol 102(10):755–763

    Article  CAS  Google Scholar 

  29. Yang XD, Zhao LY, Zheng QS, Li X (2003) Effects of arginine vasopressin on growth of rat cardiac fibroblasts: role of V1 receptor. J Cardiovasc Pharmacol 42:132–135

    Article  CAS  Google Scholar 

  30. Wada K, Fujimori A, Matsukawa U, Arai Y, Sudoh K, Yatsu T, Sasamata M, Miyata K (2005) Intravenous administration of conivaptan hydrochloride improves cardiac hemodynamics in rats with myocardial infarction-induced congestive heart failure. Eur J Pharmacol 507:145–151

    Article  CAS  Google Scholar 

  31. Woodman RJ, Wood KM, Kunnel A, Dedigama M, Pegoli MA, Soiza RL, Mangoni AA (2016) Patterns of drug use and serum sodium concentrations in older hospitalized patients: a latent class analysis approach. Drugs Real World Outcomes 3:383–391

    Article  Google Scholar 

  32. Palevsky PM, Bhagrath R, Greenberg A (1996) Hypernatremia in hospitalized patients. Ann Intern Med 124:197–203

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Ygal Plakht & Harel Gilutz

  2. Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel

    Arthur Shiyovich

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Arthur Shiyovich

  4. Department of Nursing, Leon and Matilda Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, Israel

    Ygal Plakht

Authors
  1. Ygal Plakht
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Correspondence to Ygal Plakht.

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Plakht, Y., Gilutz, H. & Shiyovich, A. Sodium levels during hospitalization with acute myocardial infarction are markers of in-hospital mortality: Soroka acute myocardial infarction II (SAMI-II) project. Clin Res Cardiol 107, 956–964 (2018). https://doi.org/10.1007/s00392-018-1268-5

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