FRACTIONAL SODIUM EXCRETION AND ITS RELATION TO IN-HOSPITAL MORBIDITY AND MORTALITY IN PATIENTS ADMITTED WITH DECOMPENSATED HEART FAILURE

Abstract

Objective: We aimed to correlate between urinary fractional sodium excretion as a marker of diuretic resistance in patients admitted with congestive heart failure and its impact on length of hospital stay together with in-hospital morbidity and mortality. Methodology: Total 46 decompensated heart failure patients were enrolled in this study. We decided that the urine sample from which we can calculate the FENa level will be a 24-hour sample in an attempt to decrease the variability of FENa levels. FENa = 100 x Na(urinary) x creatinine(plasma) Na(plasma) x creatinine (urinary) Intravenous furosemide was started on admission either as a continuous infusion or shots. Results: The median age was 59 years;the majority were of male gender {n=41(89%)} .NYHA heart failure class on admission revealed that 8(17.4%) patients had NYHA class III and 38(82.6%) patients had a NYHA class IV . There was no correlation between FENa and NYHA class on admission (r = -0.09. p=0.51) or with the left ventricular ejection fraction(LVEF) (r = -0.04. p=0.77).Also no correlation was found between FENa and the total furosemide dose per day (r = -0.07, p=0.64). FENa results came out with a median value of 1.5% with minimum and maximum FENa results equal to 0.05% and 5.2% respectively. The only three variables that contributed significantly to the prediction of hospital stay were Hb, LVEF, and FENa. Conclusion: FENa can be used upon the patient's admission to guide therapy with combination therapies with other classes of diuretics in attempt to reduce the hospital stay.