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Hyponatremia as a predictor of short-term mortality in patients with acute pulmonary embolism
Session:
Posters (Sessão 5 - Écran 6) - Tromboembolismo pulmonar
Speaker:
João Gouveia Fiuza
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
João Gouveia Fiuza; Vanda Devesa Neto; Joana Laranjeira Correia; Gonçalo RM Ferreira; Júlio Gil Pereira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Introduction:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> Pulmonary embolism (PE) is associated with important morbidity and mortality. Hyponatremia is associated with worse prognosis in many clinical conditions such as heart failure and </span></span></span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.5pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">cancer. Hyponatremia has recently been associated with short-term mortality in acute PE. </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Purpose:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> Study the association between hyponatremia and in-hospital mortality (IHM) and 1-month mortality (1MM) in patients with acute PE. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">This is a retrospective study of 178 patients admitted for acute PE in a Cardiology Department. Baseline characteristics, laboratory findings and disease severity were analyzed. Hyponatremia was defined as plasma sodium ≤ 135mg/dL at admission. The population was divided in two groups: hyponatremia and normal-high natremia. Chi-square and Mann-Whitney U was used for comparison between groups. Survival analysis using Kaplan-Meyer survival plots and log-rank tests were used to assess 1MM. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Results:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> Mean age was 63±18 years; 61,2% were women. Mean natremia was 139±3 mg/dL. At admission, 11,2% of patients had hyponatremia. IHM and 1MM were 5,6% and 7,3%, respectively. </span></span></span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Hyponatremia was associated with higher IHM (20% vs 4%; x</span></span></span><span style="font-size:10.5pt"><span style="font-family:Symbol"><span style="color:black"><sup>2</sup></span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">= 8, 789; p=0,02) and 1MM (25% vs 5%; x</span></span></span><span style="font-size:10.5pt"><span style="font-family:Symbol"><span style="color:black"><sup>2</sup>=</span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black"> 10.423; p<0.01). There was no significant difference between groups in sex (p=0,54), heart failure history (p=0,324), complete right bundle branch block (p=0,638) and BNP (p=0,256). In logistic regression analysis, hyponatremia was an independent mortality predictor, after adjusting to other worse prognosis markers (age (p=0,04), heart rate (p=0,01) and blood pressure (p=0,05) at admission). </span></span></span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Kaplan Meier analysis revealed significantly earlier mortality in patients with hyponatremia (2,6 vs 6,6 days; x</span></span></span><span style="font-size:10.5pt"><span style="font-family:Symbol"><span style="color:black"><sup>2</sup>=</span></span></span><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">5.889; p=0.02). </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Conclusion: </span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Hyponatremia at admission is associated with increased IHM and 1MM in patients diagnosed with acute PE. Natremia is a readily accessible and inexpensive laboratory marker that can independently predict short term mortality. It can be used to identify patients at a higher risk of adverse outcomes. </span></span></span></span></span></p>
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