Hiponatremia como Predictor de Mortalidad y Estancia Hospitalaria en Pacientes con Insuficiencia Cardiaca: Revisión Sistemática y Metaanálisis
Palabras clave:
insuficiencia cardiaca, hiponatremia, mortalidad, estancia hospitalaria, pronóstico
Resumen
Introducción: La hiponatremia es una alteración frecuente en pacientes con insuficiencia cardiaca y se ha asociado con mayor gravedad clínica, mortalidad y utilización de recursos hospitalarios. Su valor pronóstico podría depender tanto de la concentración sérica al ingreso como de su evolución durante la hospitalización. Objetivo: Evaluar la asociación entre hiponatremia y mortalidad, así como su relación con la duración de la estancia hospitalaria, en pacientes adultos con insuficiencia cardiaca. Metodología: Se realizó una revisión sistemática siguiendo PRISMA 2020, a partir de un corpus preliminar de 29 referencias proporcionadas. Se consideraron estudios observacionales, registros y cohortes que evaluaran hiponatremia o sodio sérico en relación con mortalidad intrahospitalaria, mortalidad durante el seguimiento o estancia hospitalaria. Las revisiones sistemáticas y metaanálisis previos se utilizaron únicamente para contextualización y no como unidades independientes de análisis cuantitativo. Resultados: La evidencia mostró una asociación consistente entre concentraciones reducidas de sodio y mayor mortalidad. En el registro ESC-HFA EORP, aproximadamente 20% de los pacientes presentó hiponatremia al ingreso y la mortalidad intrahospitalaria fue mayor en este grupo que en pacientes sin hiponatremia. La persistencia de hiponatremia durante la hospitalización identificó al subgrupo con peor pronóstico. Asimismo, estudios de gran tamaño mostraron un gradiente de riesgo conforme disminuyó la natremia. La relación con la estancia hospitalaria fue clínicamente relevante, aunque menos homogénea que la evidencia sobre mortalidad. Conclusiones: La hiponatremia constituye un marcador pronóstico relevante en insuficiencia cardiaca, especialmente cuando persiste durante la hospitalización. Sin embargo, su interpretación debe realizarse como indicador de gravedad clínica y no como un factor causal aislado. Se requieren análisis cuantitativos homogéneos y estudios prospectivos para definir con mayor precisión su valor en la estratificación de riesgo.
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4. Mondellini GM, Verbrugge FH. Evaluation and Management of Hyponatremia in Heart Failure. Current heart failure reports. 2024 Feb 27; https://pubmed.ncbi.nlm.nih.gov/38411885/
5. Durrani O, Saeed S, Kanwel S, Khaliq M, Farrukh A. Evaluating hyponatremia as a predictor of mortality in heart failure patients in a tertiary healthcare setting. Cureus [Internet]. marzo de 2025; 17(11):e96048. Disponible en: https://pubmed.ncbi.nlm.nih.gov/41356886/
6. Abdullah M, Chaudhry M, Iqbal N, Sharif W, Osama Gulzar, Malik A. Impact of serum sodium levels at the time of admission on length of hospital stay and in-hospital mortality among heart failure patients. Pakistan Armed Forces Medical Journal [Internet]. 2 de julio de 2026; 73(SUPPL-1):S14-17. Disponible en: https://pafmj.org/index.php/PAFMJ/article/view/4999
7. Zhao L, Zhao X, Zhuang X, Zhai M, Wang Y, Huang Y, et al. Hyponatremia and lower normal serum sodium levels are associated with an increased risk of all-cause death in heart failure patients. Nursing open [Internet]. junio de 2023;10(6):3799-809. Disponible en:
https://pubmed.ncbi.nlm.nih.gov/36929057/
8. Rivera JC, Nuñez D, Millar E, Ramirez K, Chandía M, Aguayo C. Mutations in the bZip region of the CEBPA gene: A novel prognostic factor in patients with acute myeloid leukemia. International Journal of Laboratory Hematology [Internet]. 1 de diciembre de 2023;45(6):833-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/37621152/
9. Mihai G, Abraham WT, Albert NM, Gattis Stough W, Greenberg BH, O’Connor CM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: An analysis from the OPTIMIZE-HF registry. European Heart Journal [Internet]. 19 de febrero de 2007;28(8):980-8. Disponible en:
https://doi.org/10.1093/eurheartj/ehl542
10. Vicent L, Alvarez-Garcia J, Gonzalez-Juanatey JR, Rivera M, Segovia J, Worner F, et al. Prognostic impact of hyponatraemia and hypernatraemia at admission and discharge in heart failure patients with preserved, mid-range and reduced ejection fraction. Internal Medicine Journal [Internet]. junio de 2021;51(6):930-8. Disponible en:
https://pubmed.ncbi.nlm.nih.gov/32237007/
11. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, et al. The global health and economic burden of hospitalizations for heart failure. Journal of the American College of Cardiology. abril de 2014;63(12):1123-33.
12. Abebe TB, Gebreyohannes EA, Tefera YG, Bhagavathula AS, Erku DA, Belachew SA, et al. The prognosis of heart failure patients: Does sodium level play a significant role? PLoS ONE [Internet]. 8 de noviembre de 2018;13(11). Disponible en:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224129/
13. Iddrisu MD, Rodriguez E. Prognostic value of spot urinary sodium in acute heart failure: A systematic review and meta-analysis. Journal of the American College of Cardiology. abril de 2025;85(12):1724.
14. Rusinaru D, Tribouilloy C, Berry C, Richards AM, Whalley GA, Earle N, et al. Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure patients with preserved and with reduced ejection fraction: An individual patient data meta-analysis. European Journal of Heart Failure. Octubre de 2012;14(10):1139-46.
15. Wang J, Zhou W, Yin X. Improvement of hyponatremia is associated with lower mortality risk in patients with acute decompensated heart failure: A meta-analysis of cohort studies. Heart failure reviews [Internet]. marzo de 2019;24(2):209-17. Disponible en:
https://pubmed.ncbi.nlm.nih.gov/30535839/
16. Zhao W, Qin J, Lu G, Wang Y, Qiao L, Li Y. Association between hyponatremia and adverse clinical outcomes of heart failure: Current evidence based on a systematic review and meta-analysis. Frontiers in cardiovascular medicine. 22 de diciembre de 2023;10.
17. Lorido JCA, Gómez JC, Formiga F, Pérez-Barquero MM, Vila JCT, Bodas OA, et al. Hyponatremia as predictor of worse outcome in real world patients admitted with acute heart failure. Cardiology Journal. 3 de octubre de 2013;20(5):506-12.
18. Shchekochikhin DY, Schrier RW, Lindenfeld J, Price LL, Jaber BL, Madias NE. Outcome differences in community- versus hospital-acquired hyponatremia in patients with a diagnosis of heart failure. Circulation: Heart Failure. mayo de 2013;6(3):379-86.
19. Younis A, Tabi M, Kashani KB, Dahiya G, Jokhadar M, Hillerson DB, et al. Echocardiographic correlates of hyponatremia in critically ill patients with heart failure. International Journal of Heart Failure. 2025;7(4):243.
20. Lee H, Kim EJ, Han SW, Park SM, Kim HS, Cho MC, et al. Advancements and Challenges in Acute Heart Failure Management in Korea: Initial Report and Insights from the Korean Heart Failure III Registry. J Card Fail. 2025. doi: 10.1016/j.cardfail.2025.07.023. Available from: https://doi.org/10.1016/j.cardfail.2025.07.023
21. Asefa ET, Woyimo TG, Bame HF, Abera EG. Time to Mortality and Predictive Factors Among Adult Heart Failure Patients: Lessons From a Resource-Limited Setting. Cardiol Res Pract. 2025;2025:3968055. doi: 10.1155/crp/3968055. Available from:
https://doi.org/10.1155/crp/3968055
22. Biswas S, Qammar B, Srivastava Y, Achlaram CM, Baig MMA, Manzoor I, Tariq B, Umar M, Khan MAF, Rana JS. Electrolyte abnormalities and clinical outcomes in heart failure patients: a retrospective cohort study using MIMIC-IV database. Sci Rep. 2026;16:25363. doi:10.1038/s41598-026-55290-6. Available from: https://doi.org/10.1038/s41598-026-55290-6
23. Kang C, Asemota I, Reyes Pinzon V, Khamooshi P, Atluri R, Soon-Shiong R. Hyponatremia and in-hospital outcomes of patients admitted for heart failure: Analysis of the national inpatient sample. European Heart Journal [Internet]. 3 de octubre de 2022; 43(Supplement_2). Disponible en: https://doi.org/10.1093/eurheartj/ehac544.1069
24. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. New England Journal of Medicine [Internet]. 3 de marzo de 2011;364(9):797-805. Disponible en:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412356/
25. Sohail R, Khan Z, Shah HH, Mansoor H, Khattak R. Exploring the clinical impact of hyponatremia in hospitalized heart failure patients: A nationwide inpatient analysis. International Journal of Cardiology and Cardiovascular Diseases [Internet]. 24 de enero de 2026;6(1):4. Disponible en: https://www.probiologists.com/article/exploring-the-clinical-impact-of-hyponatremia-in-hospitalized-heart-failure-patients-a-nationwide-inpatient-analysis
26. Adan Naib, Saman Batool, Muhammad Waqas, Muhammad Hashim Khan, Uzma Shuaib, Hafiz Shahzad Muzammil. hyponatremia as a predictor of in-hospital mortality in diabetic vs. non-diabetic heart failure patients. Journal of Health, Wellness and Community Research [Internet]. 28 de febrero de 2026;e1288. Disponible en:
https://jhwcr.com/index.php/jhwcr/article/view/1288
27. Shahzad MA, Saleemi MS, Mohyuddin MT, Hashmi KA, Akhtar A, Tariq H. Association of admission hyponatremia with in-hospital mortality in patients with acute heart failure: A prospective cohort study. Pakistan Heart Journal [Internet]. 1 de mayo de 2026;59(2):417-22. Disponible en: https://pakheartjournal.com/index.php/pk/article/view/3490
28. Christopoulou E, Liamis G, Naka K, Touloupis P, Gkartzonikas I, Florentin M. Hyponatremia in patients with heart failure beyond the neurohormonal activation associated with reduced cardiac output: A holistic approach. Cardiology [Internet]. 2022;147(5-6):507-20. Disponible en: https://www.karger.com/Article/FullText/526912
29. Breen T, Brueske B, Sidhu MS, Murphree DH, Kashani KB, Barsness GW, et al. Abnormal serum sodium is associated with increased mortality among unselected cardiac intensive care unit patients. Journal of the American Heart Association. 21 de enero de 2020;9(2).
2. Kapłon-Cieślicka A, Benson L, Chioncel O, Crespo-Leiro MG, Coats AJS, Anker S D, et al. Hyponatraemia and changes in natraemia during hospitalization for acute heart failure and associations with in-hospital and long-term outcomes - from the ESC-HFA eorp heart failure long-term registry. European journal of heart failure [Internet]. septiembre de 2023;25(9):1571-83. Disponible en: https://pubmed.ncbi.nlm.nih.gov/37114294/
3. Wilcox CS, Testani JM, Pitt B. Pathophysiology of Diuretic Resistance and Its Implications for the Management of Chronic Heart Failure. Hypertension [Internet]. 2020 Oct;76(4):1045–54. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10683075/
4. Mondellini GM, Verbrugge FH. Evaluation and Management of Hyponatremia in Heart Failure. Current heart failure reports. 2024 Feb 27; https://pubmed.ncbi.nlm.nih.gov/38411885/
5. Durrani O, Saeed S, Kanwel S, Khaliq M, Farrukh A. Evaluating hyponatremia as a predictor of mortality in heart failure patients in a tertiary healthcare setting. Cureus [Internet]. marzo de 2025; 17(11):e96048. Disponible en: https://pubmed.ncbi.nlm.nih.gov/41356886/
6. Abdullah M, Chaudhry M, Iqbal N, Sharif W, Osama Gulzar, Malik A. Impact of serum sodium levels at the time of admission on length of hospital stay and in-hospital mortality among heart failure patients. Pakistan Armed Forces Medical Journal [Internet]. 2 de julio de 2026; 73(SUPPL-1):S14-17. Disponible en: https://pafmj.org/index.php/PAFMJ/article/view/4999
7. Zhao L, Zhao X, Zhuang X, Zhai M, Wang Y, Huang Y, et al. Hyponatremia and lower normal serum sodium levels are associated with an increased risk of all-cause death in heart failure patients. Nursing open [Internet]. junio de 2023;10(6):3799-809. Disponible en:
https://pubmed.ncbi.nlm.nih.gov/36929057/
8. Rivera JC, Nuñez D, Millar E, Ramirez K, Chandía M, Aguayo C. Mutations in the bZip region of the CEBPA gene: A novel prognostic factor in patients with acute myeloid leukemia. International Journal of Laboratory Hematology [Internet]. 1 de diciembre de 2023;45(6):833-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/37621152/
9. Mihai G, Abraham WT, Albert NM, Gattis Stough W, Greenberg BH, O’Connor CM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: An analysis from the OPTIMIZE-HF registry. European Heart Journal [Internet]. 19 de febrero de 2007;28(8):980-8. Disponible en:
https://doi.org/10.1093/eurheartj/ehl542
10. Vicent L, Alvarez-Garcia J, Gonzalez-Juanatey JR, Rivera M, Segovia J, Worner F, et al. Prognostic impact of hyponatraemia and hypernatraemia at admission and discharge in heart failure patients with preserved, mid-range and reduced ejection fraction. Internal Medicine Journal [Internet]. junio de 2021;51(6):930-8. Disponible en:
https://pubmed.ncbi.nlm.nih.gov/32237007/
11. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, et al. The global health and economic burden of hospitalizations for heart failure. Journal of the American College of Cardiology. abril de 2014;63(12):1123-33.
12. Abebe TB, Gebreyohannes EA, Tefera YG, Bhagavathula AS, Erku DA, Belachew SA, et al. The prognosis of heart failure patients: Does sodium level play a significant role? PLoS ONE [Internet]. 8 de noviembre de 2018;13(11). Disponible en:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224129/
13. Iddrisu MD, Rodriguez E. Prognostic value of spot urinary sodium in acute heart failure: A systematic review and meta-analysis. Journal of the American College of Cardiology. abril de 2025;85(12):1724.
14. Rusinaru D, Tribouilloy C, Berry C, Richards AM, Whalley GA, Earle N, et al. Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure patients with preserved and with reduced ejection fraction: An individual patient data meta-analysis. European Journal of Heart Failure. Octubre de 2012;14(10):1139-46.
15. Wang J, Zhou W, Yin X. Improvement of hyponatremia is associated with lower mortality risk in patients with acute decompensated heart failure: A meta-analysis of cohort studies. Heart failure reviews [Internet]. marzo de 2019;24(2):209-17. Disponible en:
https://pubmed.ncbi.nlm.nih.gov/30535839/
16. Zhao W, Qin J, Lu G, Wang Y, Qiao L, Li Y. Association between hyponatremia and adverse clinical outcomes of heart failure: Current evidence based on a systematic review and meta-analysis. Frontiers in cardiovascular medicine. 22 de diciembre de 2023;10.
17. Lorido JCA, Gómez JC, Formiga F, Pérez-Barquero MM, Vila JCT, Bodas OA, et al. Hyponatremia as predictor of worse outcome in real world patients admitted with acute heart failure. Cardiology Journal. 3 de octubre de 2013;20(5):506-12.
18. Shchekochikhin DY, Schrier RW, Lindenfeld J, Price LL, Jaber BL, Madias NE. Outcome differences in community- versus hospital-acquired hyponatremia in patients with a diagnosis of heart failure. Circulation: Heart Failure. mayo de 2013;6(3):379-86.
19. Younis A, Tabi M, Kashani KB, Dahiya G, Jokhadar M, Hillerson DB, et al. Echocardiographic correlates of hyponatremia in critically ill patients with heart failure. International Journal of Heart Failure. 2025;7(4):243.
20. Lee H, Kim EJ, Han SW, Park SM, Kim HS, Cho MC, et al. Advancements and Challenges in Acute Heart Failure Management in Korea: Initial Report and Insights from the Korean Heart Failure III Registry. J Card Fail. 2025. doi: 10.1016/j.cardfail.2025.07.023. Available from: https://doi.org/10.1016/j.cardfail.2025.07.023
21. Asefa ET, Woyimo TG, Bame HF, Abera EG. Time to Mortality and Predictive Factors Among Adult Heart Failure Patients: Lessons From a Resource-Limited Setting. Cardiol Res Pract. 2025;2025:3968055. doi: 10.1155/crp/3968055. Available from:
https://doi.org/10.1155/crp/3968055
22. Biswas S, Qammar B, Srivastava Y, Achlaram CM, Baig MMA, Manzoor I, Tariq B, Umar M, Khan MAF, Rana JS. Electrolyte abnormalities and clinical outcomes in heart failure patients: a retrospective cohort study using MIMIC-IV database. Sci Rep. 2026;16:25363. doi:10.1038/s41598-026-55290-6. Available from: https://doi.org/10.1038/s41598-026-55290-6
23. Kang C, Asemota I, Reyes Pinzon V, Khamooshi P, Atluri R, Soon-Shiong R. Hyponatremia and in-hospital outcomes of patients admitted for heart failure: Analysis of the national inpatient sample. European Heart Journal [Internet]. 3 de octubre de 2022; 43(Supplement_2). Disponible en: https://doi.org/10.1093/eurheartj/ehac544.1069
24. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. New England Journal of Medicine [Internet]. 3 de marzo de 2011;364(9):797-805. Disponible en:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412356/
25. Sohail R, Khan Z, Shah HH, Mansoor H, Khattak R. Exploring the clinical impact of hyponatremia in hospitalized heart failure patients: A nationwide inpatient analysis. International Journal of Cardiology and Cardiovascular Diseases [Internet]. 24 de enero de 2026;6(1):4. Disponible en: https://www.probiologists.com/article/exploring-the-clinical-impact-of-hyponatremia-in-hospitalized-heart-failure-patients-a-nationwide-inpatient-analysis
26. Adan Naib, Saman Batool, Muhammad Waqas, Muhammad Hashim Khan, Uzma Shuaib, Hafiz Shahzad Muzammil. hyponatremia as a predictor of in-hospital mortality in diabetic vs. non-diabetic heart failure patients. Journal of Health, Wellness and Community Research [Internet]. 28 de febrero de 2026;e1288. Disponible en:
https://jhwcr.com/index.php/jhwcr/article/view/1288
27. Shahzad MA, Saleemi MS, Mohyuddin MT, Hashmi KA, Akhtar A, Tariq H. Association of admission hyponatremia with in-hospital mortality in patients with acute heart failure: A prospective cohort study. Pakistan Heart Journal [Internet]. 1 de mayo de 2026;59(2):417-22. Disponible en: https://pakheartjournal.com/index.php/pk/article/view/3490
28. Christopoulou E, Liamis G, Naka K, Touloupis P, Gkartzonikas I, Florentin M. Hyponatremia in patients with heart failure beyond the neurohormonal activation associated with reduced cardiac output: A holistic approach. Cardiology [Internet]. 2022;147(5-6):507-20. Disponible en: https://www.karger.com/Article/FullText/526912
29. Breen T, Brueske B, Sidhu MS, Murphree DH, Kashani KB, Barsness GW, et al. Abnormal serum sodium is associated with increased mortality among unselected cardiac intensive care unit patients. Journal of the American Heart Association. 21 de enero de 2020;9(2).
Publicado
2026-11-11
Cómo citar
Soto Piña , P. I., García Ruíz , X., Mendoza Tlacomulco , J., Mancilla Gómez , E. A., Alemán Gómez , A., Pérez Rechy, J. D. C., Villasana Hernandez, P. D. C., Montiel Palacios, M. J., & Enriquez Minero , S. (2026). Hiponatremia como Predictor de Mortalidad y Estancia Hospitalaria en Pacientes con Insuficiencia Cardiaca: Revisión Sistemática y Metaanálisis. Ciencia Latina Revista Científica Multidisciplinar, 10(5), 7671-7693. https://doi.org/10.37811/cl_rcm.v10i5.26247
Número
Sección
Ciencias de la Salud
Derechos de autor 2026 Pamela Ileana Soto Piña , Ximena García Ruíz , Jedlaf Mendoza Tlacomulco , Erick Alejandro Mancilla Gómez , Arleth Alemán Gómez , Julieta Del Carmen Pérez Rechy, Paola Del Carmen Villasana Hernandez, María José Montiel Palacios, Santiago Enriquez Minero
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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