Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 15, Number 5, October 2024, pages 350-357

Effect of Post-Loop Diuretic Urinary Sodium Level on Length of Stay and Rehospitalization in Acutely Decompensated Heart Failure Patients

Figure 1. Pearson correlation result showing trends of significant correlation between pre-loop diuretic (LD) sodium urine and length of stay (LOS) (r = -0.238, P = 0.093).

Figure 2. Pearson correlation result showing a statistically significant correlation between post-loop diuretic (LD) sodium urine and length of stay (LOS) (r = -0.308, P = 0.028).

**Table 1.** Baseline Characteristics of Study Subjects (N = 51)
SD: standard deviation; ARB: angiotensin receptor blocker.
Gender, n (%)
Male	40 (78.4)
Female	11 (21.6)
Age (years), mean ± SD	52.47 ± 13.62
Left ventricular ejection fraction (%), mean ± SD	37.53 ± 17.95
Left ventricular ejection fraction category, n (%)
> 50%	14 (27.4)
40-50%	5 (9.8)
< 40%	32 (62.7)
Systolic blood pressure (mm Hg), mean ± SD	124.22 ± 26.35
Diastolic blood pressure (mm Hg), mean ± SD	74.76 ± 17.45
Glomerular filtration rate (mL/min/1.73 m²), mean ± SD	57.29 ± 27.25
Random blood glucose (mg/dL), mean ± SD	134.43 ± 46.83
Diuretic administration strategy
Nonaggressive	21 (41.2)
Aggressive	30 (58.8)
Angiotensin-converting enzyme inhibitors/ARB, n (%)	40 (78.4)
Beta-blockers, n (%)	36 (70.6)
Adherence to medication regiments, n (%)	11 (21.6)
Baseline urinary and sodium levels
Serum sodium (mmol/L)
Pre-loop diuretic (mean ± SD)	134.18 ± 4.55
Post-loop diuretic (mean ± SD)	135.53 ± 4.33
Urinary sodium (mmol/L)
Pre-loop diuretic (mean ± SD)	67.69 ± 40.1
Post-loop diuretic (mean ± SD)	87.78 ± 36.37
Pre-loop diuretic urinary sodium, n (% of subjects)
< 50 mmol/L	21(41.2)
> 50 mmol/L	30 (58.8)
Post-loop diuretic urinary sodium, n (% of subjects)
< 50 mmol/L	12 (23.5)
> 50 mmol/L	39 (76.5)

Table 1. Baseline Characteristics of Study Subjects (N = 51)

SD: standard deviation; ARB: angiotensin receptor blocker.

Gender, n (%)

Male

40 (78.4)

Female

11 (21.6)

Age (years), mean ± SD

52.47 ± 13.62

Left ventricular ejection fraction (%), mean ± SD

37.53 ± 17.95

Left ventricular ejection fraction category, n (%)

> 50%

14 (27.4)

40-50%

5 (9.8)

< 40%

32 (62.7)

Systolic blood pressure (mm Hg), mean ± SD

124.22 ± 26.35

Diastolic blood pressure (mm Hg), mean ± SD

74.76 ± 17.45

Glomerular filtration rate (mL/min/1.73 m²), mean ± SD

57.29 ± 27.25

Random blood glucose (mg/dL), mean ± SD

134.43 ± 46.83

Diuretic administration strategy

Nonaggressive

21 (41.2)

Aggressive

30 (58.8)

Angiotensin-converting enzyme inhibitors/ARB, n (%)

40 (78.4)

Beta-blockers, n (%)

36 (70.6)

Adherence to medication regiments, n (%)

11 (21.6)

Baseline urinary and sodium levels

Serum sodium (mmol/L)

Pre-loop diuretic (mean ± SD)

134.18 ± 4.55

Post-loop diuretic (mean ± SD)

135.53 ± 4.33

Urinary sodium (mmol/L)

Pre-loop diuretic (mean ± SD)

67.69 ± 40.1

Post-loop diuretic (mean ± SD)

87.78 ± 36.37

Pre-loop diuretic urinary sodium, n (% of subjects)

< 50 mmol/L

21(41.2)

> 50 mmol/L

30 (58.8)

Post-loop diuretic urinary sodium, n (% of subjects)

< 50 mmol/L

12 (23.5)

> 50 mmol/L

39 (76.5)

**Table 2.** Comparison of Length of Stay Between Variables
	Length of stay (days) (mean ± SD)	P value
Pre-loop diuretic urinary sodium
≤ 50 mmol/L (n = 21)	8.57 ± 6.161	0.04
> 50 mmol/L (n = 30)	5.30 ± 4.01
Post-loop diuretic urinary sodium
≤ 50 mmol/L (n = 12)	8.67 ± 4.14	0.126
> 50 mmol/L (n = 39)	6.03 ± 5.39
Gender
Male (n = 40)	6.28 ± 4.89	0.417
Female (n = 11)	8.00 ± 6.34
Diuretic administration strategy
Nonaggressive (n = 21)	6.43 ± 3.84	0.805
Aggressive (n = 30)	6.80 ± 6.05

Table 2. Comparison of Length of Stay Between Variables

Length of stay (days) (mean ± SD)

P value

Pre-loop diuretic urinary sodium

≤ 50 mmol/L (n = 21)

8.57 ± 6.161

0.04

> 50 mmol/L (n = 30)

5.30 ± 4.01

Post-loop diuretic urinary sodium

≤ 50 mmol/L (n = 12)

8.67 ± 4.14

0.126

> 50 mmol/L (n = 39)

6.03 ± 5.39

Gender

Male (n = 40)

6.28 ± 4.89

0.417

Female (n = 11)

8.00 ± 6.34

Diuretic administration strategy

Nonaggressive (n = 21)

6.43 ± 3.84

0.805

Aggressive (n = 30)

6.80 ± 6.05

**Table 3.** Factors Associated With Rehospitalization in 30 Days
	Rehospitalization in 30 days after discharge	P value
ACE: angiotensin-converting enzyme; SD: standard deviation; SBP: systolic blood pressure; DBP: diastolic blood pressure.
Male gender	9 (100%)	31 (73.8%)	0.177
Aggressive diuretic strategy	4 (44.4%)	25 (59.5%)	1.00
ACE inhibitor/angiotensin receptor blocker use during hospitalization	5 (55.6%)	35 (83.3%)	0.087
Beta-blocker use during hospitalization	3 (33.3%)	33 (78.6%)	0.013
Non-adherence to medication prescribed	6 (66.67%)	34 (80.9%)	0.958
Serum sodium pre-loop diuretic	132.00 ± 4.183	134.64 ± 4.536	0.115
Serum sodium post-loop diuretic	133.89 ± 5.968	135.88 ± 3.902	0.362
Pre-loop diuretic urinary sodium	46.44 ± 30.99	72.27 ± 40.64	0.05
≤ 50 mmol/L (n = 21)	5 (55.6)	16 (38.1)	0.46
> 50 mmol/L (n = 30)	4 (44.4)	26 (61.9)
Post-loop diuretic urinary sodium	77.44 ± 30.67	90.00 ± 37.43	0.300
≤ 50 mmol/L (n = 12)	2 (22.2)	10 (23.8)	1.000
> 50 mmol/L (n = 39)	7 (77.8)	32 (76.2)
Age (years), mean ± SD	53.22 ± 13.24	49.89 ± 16.28	0.536
Left ventricular ejection fraction (%), mean ± SD	38.03 ± 18.16	35.22 ± 17.75	0.674
SBP (mm Hg), mean ± SD	127.45 ± 27.29	109.11 ± 14.56	0.057
DBP (mm Hg), mean ± SD	76.05 ± 18.30	68.78 ± 11.745	0.261
Glomerular filtration rate, mean ± SD	55.88 ± 27.62	63.89 ± 25.96	0.429
Random blood glucose (mg/dL), median (IQR)	137.24 ± 50.38	121.33 ± 22.215	0.361

Table 3. Factors Associated With Rehospitalization in 30 Days

Rehospitalization in 30 days after discharge

P value

Yes (n = 9)

No (n = 42)

ACE: angiotensin-converting enzyme; SD: standard deviation; SBP: systolic blood pressure; DBP: diastolic blood pressure.

Male gender

9 (100%)

31 (73.8%)

0.177

Aggressive diuretic strategy

4 (44.4%)

25 (59.5%)

1.00

ACE inhibitor/angiotensin receptor blocker use during hospitalization

5 (55.6%)

35 (83.3%)

0.087

Beta-blocker use during hospitalization

3 (33.3%)

33 (78.6%)

0.013

Non-adherence to medication prescribed

6 (66.67%)

34 (80.9%)

0.958

Serum sodium pre-loop diuretic

132.00 ± 4.183

134.64 ± 4.536

0.115

Serum sodium post-loop diuretic

133.89 ± 5.968

135.88 ± 3.902

0.362

Pre-loop diuretic urinary sodium

46.44 ± 30.99

72.27 ± 40.64

0.05

≤ 50 mmol/L (n = 21)

5 (55.6)

16 (38.1)

0.46

> 50 mmol/L (n = 30)

4 (44.4)

26 (61.9)

Post-loop diuretic urinary sodium

77.44 ± 30.67

90.00 ± 37.43

0.300

≤ 50 mmol/L (n = 12)

2 (22.2)

10 (23.8)

1.000

> 50 mmol/L (n = 39)

7 (77.8)

32 (76.2)

Age (years), mean ± SD

53.22 ± 13.24

49.89 ± 16.28

0.536

Left ventricular ejection fraction (%), mean ± SD

38.03 ± 18.16

35.22 ± 17.75

0.674

SBP (mm Hg), mean ± SD

127.45 ± 27.29

109.11 ± 14.56

0.057

DBP (mm Hg), mean ± SD

76.05 ± 18.30

68.78 ± 11.745

0.261

Glomerular filtration rate, mean ± SD

55.88 ± 27.62

63.89 ± 25.96

0.429

Random blood glucose (mg/dL), median (IQR)

137.24 ± 50.38

121.33 ± 22.215

0.361

**Table 4.** Multivariate (Linear Regression) Analysis on Factors Associated With Length of Stay
Variables	Unstandardized coefficients	Standardized coefficient	t	P value
SE: standard error.
Glomerular filtration rate	-0.014	0.026	-0.074	-0.537	0.594
Serum sodium pre-loop diuretic	0.484	0.254	0.423	1.908	0.063
Serum sodium post-loop diuretic	-0.387	0.230	-0.322	-1.683	0.099
Urine sodium pre-loop diuretics	-0.026	0.021	-0.202	-1.265	0.212
Urine sodium post-loop diuretics	-0.49	0.023	-0.342	-2.100	0.041

Table 4. Multivariate (Linear Regression) Analysis on Factors Associated With Length of Stay

Variables

Unstandardized coefficients

Standardized coefficient

P value

SE: standard error.

Glomerular filtration rate

-0.014

0.026

-0.074

-0.537

0.594

Serum sodium pre-loop diuretic

0.484

0.254

0.423

1.908

0.063

Serum sodium post-loop diuretic

-0.387

0.230

-0.322

-1.683

0.099

Urine sodium pre-loop diuretics

-0.026

0.021

-0.202

-1.265

0.212

Urine sodium post-loop diuretics

-0.49

0.023

-0.342

-2.100

0.041