The Role of Urine Na+ Levels as A Predictor of Diuresis Response, Length of Stay, Rehospitalization And Death Due to Cardiovascular Disease In 30 Days Post Treatment in Acute Heart Failure Patients

Abstract

Background: The incidence of rehospitalization and death due to cardiovascular disease in acute heart failure (AHF) is relatively high. The spot urine Na+ value 6 and 48 hours after loop diuretic still does not have a clear role as a predictor of diuresis response, length of stay, rehospitalization as well as the composite of rehospitalization events and death due to cardiovascular disease within 30 days. Objective: To determine whether spot urinary Na+ 6 hours and 48 hours after loop diuretic is a predictor of diuresis response, length of stay, rehospitalization as well as a composite of events within 30 days. Methods: This study is a prospective cohort of AHF patients treated in February-March 2024. The independent variable is the spot urine Na+ value 6 and 48 hours after loop diuretic. Outcomes consist of diuresis response, length of stay, rehospitalization as well as a composite of rehospitalization and death due to cardiovascular disease within 30 days. Results: A total of 72 AHF patients were included in the study. Rehospitalization events occurred in 20.8% of cases while composite events occurred in 22.2%. The cut point value for spot urinary Na+ 6 hours after loop diuretic in this study was 62.3 mmol/L. 6-hour spot urine Na+ was a predictor of poor diuresis response with adjusted OR 3.67 (95% CI 1.12-11.8; p < 0.03). Regression analysis showed that 6-hour spot urine Na+ was not a predictor of length of stay (β coefficient: -0,023 95% CI -0,054 – 0,008; p = 0.138). 6-hour spot urine Na+ was a predictor of rehospitalization with adjusted HR 3.53 (95% CI 1.11-11.18; p = 0.032). The 6-hour spot urine Na+ value was a composite predictor of 30-day events with HR 4.89 (95% CI 1.58-15.11; p = 0.006). No association was found between 48-hour spot urine Na+ values with diuresis response, length of stay, rehospitalization and events within 30 days. Conclusion: Spot urine Na+ value 6 hours after loop diuretic is a predictor of diuresis response, rehospitalization and composite events within 30 days. The 6-hour urine Na+ spot value is not a predictor of length of stay. The 48-hour urine Na+ spot value is not a predictor of diuresis response, length of stay, rehospitalization or composite events within 30 days.