International Journal of Medical and All Body Health Research  |  e-ISSN: 2582-8940  |  Double-Blind Peer Review  |  Open Access  |  CC BY-NC-SA 4.0

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     2026:7/4

International Journal of Medical and All Body Health Research

e-ISSN: 2582-8940 | Open Access

Role of Serum Sodium Level in Predicting Mortality in Patients with Heart Failure: A Prospective Cohort Study

Fadhil Hani Abbas, Basim Dhawi Dakhil

M.B.Ch.B, C.A.B.M.S, F.I.B.M.S (Cardiology), Ibn Al-Bitar Center for Cardiac Surgery, Ministry of Health, Baghdad, Iraq; M.B.Ch.B, F.I.B.M.S (Specialist in Internal Medicine), Baghdad Teaching Hospital, Ministry of Health, Baghdad, Iraq

Article Information

Volume / Issue7 / 4 (October-December 2026)
Pages41-45
AccessOpen Access

Publication Timeline

  • Received08 August 2026
  • Accepted07 September 2026
  • Published

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Abstract

Background: Heart failure is associated with substantial morbidity and mortality. Patients with heart failure often exhibit hyponatremia and may reflect hemodynamic and neurohormonal disturbances.
Aim of study: To evaluate the role of serum sodium level as a predictor of mortality among patients with HF in Iraq.
Methods: A prospective cohort study was conducted among 100 adult patients with heart failure admitted to the Internal Medicine Department of Baghdad Teaching Hospital between July 2025 and July 2026. It included 100 adult patients who presented to the adult patients with HF hospitalized to the hospital with left ventricular ejection fraction < 49% at admission and followed up to evaluate in-hospital mortality. Demographic and clinical characteristics, laboratory parameters, ejection fraction, duration of hospitalization, and patient outcome were recorded.
Results: In this study, hyponatremia was present in 58% of patients. Overall, 32% of patients died. Mortality was significantly higher among patients with hyponatremia than among those with normal serum sodium levels (43.1% vs. 16.7%, P=0.005). Patients with hyponatremia also had a significantly longer duration of hospitalization, lower systolic and diastolic blood pressures, and higher mean heart rate than patients with normal sodium levels (P < 0.001). 
Conclusions: Serum sodium is an inexpensive, readily available clinical marker for risk stratification and prognostic assessment in patients with heart failure as hyponatremia is common among hospitalized patients with heart failure and is significantly associated with increased mortality.
 

Keywords

Hyponatremiaheart failuremortalitypredictorsodium

References

  1. Valente V, Laborante R, Abdin A, Becher PM, Lainscak M, Polovina M, et al. The global epidemiology of heart failure: a comprehensive and contemporary review. Eur J Heart Fail. 2026;28(3):347-73. [Google Scholar][Crossref]
  2. Ran J, Zhou P, Wang J, Zhao X, Huang Y, Zhou Q, et al. Global, regional, and national burden of heart failure and its underlying causes, 1990-2021: results from the Global Burden of Disease Study 2021. Biomark Res. 2025;13(1):16. [Google Scholar][Crossref]
  3. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. Variable Serum Sodium level P- Value Hyponatremia Mean ± SD Normal level Mean ± SD BMI (kg/m 2 ) 27.33 ± 6.3 25.98 ± 4.6 0.126 Duration of hospitalization (day) 4.98 ± 1.92 6.78 ± 1.44 < 0.001 EF (%) 36.2 ± 5.41 37.3 ± 6.32 0.411 SBP (mmHg) 101.4 ± 23.59 132.3 ± 25.14 < 0.001 DBP (mmHg) 61.81 ± 18.41 79.15 ± 10.32 < 0.001 Heart Rate (beats/min) 89.71 ± 12.1 77.6 ± 12.13 < 0.001 International Journal of Medical and All Body Health Research www.allmedicaljournal.com [Google Scholar][Crossref]
  4. Wen B, Liu M, Qin X, Mao Z, Chen X. Identifying immune cell infiltration and diagnostic biomarkers in heart failure and osteoarthritis by bioinformatics analysis. Medicine (Baltimore). 2023;102(26):e34166. [Google Scholar][Crossref]
  5. Elendu C, Amaechi DC, Elendu TC, Fiemotonghan BE, Okoye OK, Agu-Ben CM, et al. A comprehensive review of heart failure: unraveling the etiology, decoding pathophysiological mechanisms, navigating diagnostic modalities, exploring pharmacological interventions, advocating lifestyle modifications, and charting the horizon of emerging therapies in the complex landscape of chronic cardiac dysfunction. Medicine (Baltimore). 2024;103(3):e36895. [Google Scholar][Crossref]
  6. Schwinger RHG. Pathophysiology of heart failure. Cardiovasc Diagn Ther. 2021;11(1):263-76. [Google Scholar][Crossref]
  7. Li X, Pang X, Sun H, Zhang B, Wang H, Wu N, et al. Cardiac aging: molecular mechanisms and therapeutic interventions. Pharmacol Res. 2025;221:107954. [Google Scholar][Crossref]
  8. Peng Y, Zhang W, Yang Y, Shi T, Yang F, Yang S, et al. Predictive value of the serum sodium to log(D-dimer) ratio for the risk of all-cause death in patients with chronic heart failure with different ejection fractions. BMC Cardiovasc Disord. 2026;26(1):613. [Google Scholar][Crossref]
  9. Dmitrieva NI, Boehm M, Yancey PH, Enhörning S. Long-term health outcomes associated with hydration status. Nat Rev Nephrol. 2024;20(5):275-94. [Google Scholar][Crossref]
  10. Cao Z, Zhu W, Shen C, Gao B, Jin N, Li F, et al. Association of baseline serum sodium with long-term outcomes in newly diagnosed coronary heart disease patients without heart failure: a prospective cohort study. Sci Rep. 2024;14(1):18154. [Google Scholar][Crossref]
  11. Rachid A, Hmede AG, Kalash M, Tfaily A, El Sayed A. Hyponatremia in heart failure with preserved ejection fraction: pathophysiology, clinical implications, and management challenges. Cardiovasc Med. 2026;29(2):19. [Google Scholar][Crossref]
  12. Wittczak A, Ślot M, Bielecka-Dabrowa A. The importance of optimal hydration in patients with heart failure—not always too much fluid. Biomedicines. 2023;11(10):2684. [Google Scholar][Crossref]
  13. Kodjoe E. Low sodium intake and cardiovascular disease mortality among adults with hypertension. Int J Cardiol Cardiovasc Risk Prev. 2022;15:200158. [Google Scholar][Crossref]
  14. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2023;44(37):3627-39. [Google Scholar][Crossref]
  15. 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. Nurs Open. 2023;10(6):3799-809. [Google Scholar][Crossref]
  16. 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. 2022;147(5-6):507-20. [Google Scholar][Crossref]
  17. Peng S, Peng J, Yang L, Ke W. Relationship between serum sodium levels and all-cause mortality in congestive heart failure patients: a retrospective cohort study based on the MIMIC-III database. Front Cardiovasc Med. 2022;9:1082845. [Google Scholar][Crossref]
  18. 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. 2025;17(11):e96048. [Google Scholar][Crossref]
  19. Pelouto A, Reimer J, Hoorn EJ, Zandbergen AAM, den Hertog HM. Hyponatremia is associated with unfavorable outcomes after reperfusion treatment in acute ischemic stroke. Eur J Neurol. 2024;31(3):e16156. [Google Scholar][Crossref]
  20. Manolis AA, Manolis TA, Manolis AS. Neurohumoral activation in heart failure. Int J Mol Sci. 2023;24(20):15472. [Google Scholar][Crossref]
  21. Sumi H, Tominaga N, Fujita Y, Verbalis JG. Pathophysiology, symptoms, outcomes, and evaluation of hyponatremia: comprehension and best clinical practice. Clin Exp Nephrol. 2025;29(2):134-48. [Google Scholar][Crossref]
  22. Ali K, Workicho A, Gudina EK. Hyponatremia in patients hospitalized with heart failure: a condition often overlooked in low-income settings. Int J Gen Med. 2016;9:267-73. [Google Scholar][Crossref]
  23. 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. Int J Cardiol Cardiovasc Dis. 2026;6(1):4-10. [Google Scholar][Crossref]

How to Cite

Abbas, F. H., & Dakhil, B. D. (2026). Role of Serum Sodium Level in Predicting Mortality in Patients with Heart Failure: A Prospective Cohort Study. International Journal of Medical and All Body Health Research, 7(4), 41-45. https://doi.org/10.54660/IJMBHR.2026.7.4.41-45

Abbas, Fadhil Hani, and Basim Dhawi Dakhil. "Role of Serum Sodium Level in Predicting Mortality in Patients with Heart Failure: A Prospective Cohort Study." International Journal of Medical and All Body Health Research, vol. 7, no. 4, 2026, pp. 41-45. https://doi.org/10.54660/IJMBHR.2026.7.4.41-45.

Abbas, F. H. and Dakhil, B. D. (2026) 'Role of Serum Sodium Level in Predicting Mortality in Patients with Heart Failure: A Prospective Cohort Study', International Journal of Medical and All Body Health Research, 7(4), pp. 41-45. doi: 10.54660/IJMBHR.2026.7.4.41-45.

Abbas FH, Dakhil BD. Role of Serum Sodium Level in Predicting Mortality in Patients with Heart Failure: A Prospective Cohort Study. International Journal of Medical and All Body Health Research. 2026;7(4):41-45. doi:10.54660/IJMBHR.2026.7.4.41-45

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