Risk stratification and predictive value of serum sodium fluctuation for adverse prognosis in acute coronary syndrome patients

Xiangwei Bo; Yang Liu; Chunshu Hao; Hao Qian; Yuanyuan Zhao; Ya Hu; Yao Zhang; Naresh Kharbuja; Chengwei Ju; Lijuan Chen; Genshan Ma

doi:10.1016/j.cca.2023.117491

Risk stratification and predictive value of serum sodium fluctuation for adverse prognosis in acute coronary syndrome patients

Clin Chim Acta. 2023 Aug 1:548:117491. doi: 10.1016/j.cca.2023.117491. Epub 2023 Jul 14.

Authors

Xiangwei Bo¹, Yang Liu², Chunshu Hao¹, Hao Qian¹, Yuanyuan Zhao¹, Ya Hu¹, Yao Zhang¹, Naresh Kharbuja³, Chengwei Ju¹, Lijuan Chen⁴, Genshan Ma²

Affiliations

¹ Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, PR China; Department of Cardiology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, 210009, PR China; School of Medicine, Southeast University, Nanjing, 210009, PR China.
² Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, PR China; School of Medicine, Southeast University, Nanjing, 210009, PR China.
³ Suthan Research Center, Bhaktapur, Bagmati, 44800, Nepal.
⁴ Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, PR China; Department of Cardiology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, 210009, PR China; School of Medicine, Southeast University, Nanjing, 210009, PR China. Electronic address: chenlijuan@seu.edu.cn.

PMID: 37454722
DOI: 10.1016/j.cca.2023.117491

Abstract

Background: Serum sodium fluctuation (SF) as an indicator of the extent of changes in serum sodium is associated with increased mortality in hospitalized patients. However, there is no consensus on diagnostic criteria for SF, and its impact on the outcome of patients with acute coronary syndrome (ACS) remains uncertain. We defined SF and assessed its association with adverse prognosis in hospitalized ACS patients.

Methods: Patients diagnosed with ACS were consecutively recruited. The serum SF rate (SFR) was defined as the ratio of the difference between the highest and lowest serum sodium levels during hospitalization to the initial serum sodium level on admission. The Cox proportional hazards model was performed to evaluate the association between SFR and mortality. The dose-response relationships of SFR with mortality was characterized by restricted cubic splines (RCS) model. The predictive performance of SF for mortality was assessed by the area under the receiver operating characteristic curves (AUCs).

Results: The study retrospectively enrolled 1856 ACS patients, of which 36 (1.94%) patients dead within 1 year. Multivariate Cox analysis showed that SFR was independently associated with higher risk of 1-year mortality (HR = 1.17, 95% CI: 1.111-1.244, P < 0.001). RCS analysis showed the optimal threshold for SFR was 5%, and the 1-year cumulative mortality was higher in the abnormal SF group (SFR ≥ 5%) compared with the normal SF group (SFR < 5%, P < 0.01). The AUCs of SF for predicting mortality within 1 month, 6 months, and 1 year were 0.842 (95% CI: 0.781-0.904), 0.830 (95% CI:0.736-0.926), 0.703 (95% CI:0.595--0.811), respectively. Even in patients with normal baseline serum sodium, abnormal SF group demonstrated a significantly higher 1-year mortality compared to normal SF group (HR = 4.955, 95% CI: 1.919-12.795).

Conclusion: The SFR during hospitalization is an adequate predictor of adverse outcomes in ACS patients, independent of serum sodium level at admission. Additional research is warranted to ascertain whether interventions targeting SF confer measurable clinical benefits.

Keywords: Acute coronary syndrome; Mortality; Readmission; Serum sodium fluctuation.

MeSH terms

Acute Coronary Syndrome* / diagnosis
Humans
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Sodium

Substances

Sodium