Pre-Operative Hyponatremia as a Risk Factor for Mortality in Patients after Left Ventricular Assist Device Implantation
Hyponatremia is a recognized risk factor for adverse outcomes in heart failure and after cardiac surgery. We hypothesized that hyponatremia would be associated with poorer short-term and longer-term survival in patients after continuous-flow left ventricular assist device (CF-LVAD) placement. Patien...
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Published in | The Journal of heart and lung transplantation Vol. 39; no. 4; pp. S430 - S431 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Inc
01.04.2020
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Online Access | Get full text |
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Summary: | Hyponatremia is a recognized risk factor for adverse outcomes in heart failure and after cardiac surgery. We hypothesized that hyponatremia would be associated with poorer short-term and longer-term survival in patients after continuous-flow left ventricular assist device (CF-LVAD) placement.
Patients who received a CF-LVAD between January 2012 and December 2017 were identified in a single-center database. Sodium values within 14 days of LVAD insertion were averaged; hyponatremia was defined as Na < 135mEq/L. Baseline characteristics, post-operative complications and mortality were analyzed. Patients who required pre-operative dialysis were excluded from the study. The effect of pre-operative hyponatremia on short-term outcomes and long-term survival was analyzed.
Out of 322 patients, 49.7% (n=160) were found to have hyponatremia prior to LVAD insertion. There were no significant differences in comorbidities between groups. Pre-operative hyponatremia was associated with increased length of post-operative stay (38 vs 30 days, p=0.02). Though there was no difference in short-term (90-day) mortality, hyponatremia was associated with increased long-term, five-year mortality (61% vs 44%, p=0.03) (Figure 1). On binary logistic regression analysis, hyponatremia (OR 1.88 95% CI [1.073-3.315], p=0.03), increased age (OR 1.03 95% CI [1.007-1.053], p=0.01), elevated neutrophil-lymphocyte ratio (OR 1.064 95% CI [1.004-1.128], p=0.037), decreased albumin (OR 0.94 95% CI [0.887-0.992], p=0.03), and elevated mean right atrial pressure/pulmonary capillary wedge pressure ratio (OR 4.69 95% CI [1.762-12.473], p=0.002) were independent risk factors of mortality.
Pre-operative hyponatremia is associated with increased mortality after LVAD implantation and can be used as a marker or added to existing risk scores to further risk stratify patients. Whether hyponatremia correction improves long-term survival should be investigated. |
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ISSN: | 1053-2498 1557-3117 |
DOI: | 10.1016/j.healun.2020.01.225 |