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Heart Failure (HF) is a fatal disease. Several biomarkers are of interest with regard to prognosis. However, plasma osmolality which unites the individual influences of sodium, BUN and glucose has not been studied.
496 patients with HF out of two participating centers were investigated as part of a larger cohort and followed up to 111 months. Plasma osmolality was calculated as "(2*Na)+(BUN/2.8)+(Glucose/18)". When ROC curve was obtained, it was noticed that the curve is sigmoid shaped. Hence three subcategories were identified. Patients were classified into three groups as follows: Those with plasma osmolality<287 mOsm/kg (hypoosmolality), those with osmolality between 287-295 (normoosmolality, blue line in figure), and those with plasma osmolality>295 mOsm/kg (hyperosmolality).
Mean EF of the cohort was 27±10% with a mean age of 55.9±17.8 years (369 males, 127 females) Patients were followed up for 27±23 months and mortality was noted. Kaplan Meier curves for three subcategories of plasma osmolality separated from each other (p=0.0296, Figure 1). After follow up, 42.6% of those with low osmolality, 34.7% of those with high osmolality versus 22.8% of those with normoosmolality died (p=0.0003). It was also noted that up to 40 months of follow up, those with hypoosmolality (red line) had the worst prognosis, then, there was a switch between hypo and hyperosmolality groups with the hyperosmolality group (yellow line) having the worst prognosis thereafter.
Plasma osmolality predicts both mid term and long term mortality of patients.