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Hyponatraemia, hyperglycaemia and worsening renal function at first blood sample on emergency department admission as predictors of in-hospital death in patients with dyspnoea with suspected acute heart failure: retrospective observational analysis of the PARADISE cohort
  1. Tahar Chouihed1,2,3,
  2. Aurélien Buessler1,
  3. Adrien Bassand1,2,
  4. Deborah Jaeger1,2,
  5. Jean Marc Virion4,5,
  6. Lionel Nace6,
  7. Françoise Barbé7,
  8. Sylvain Salignac8,
  9. Patrick Rossignol2,3,9,
  10. Faiez Zannad2,3,9,
  11. Nicolas Girerd2,3,9
  1. 1 Emergency Department, University Hospital of Nancy, Nancy, France
  2. 2 Faculté de Médecine, INSERM, Centre d’Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre les Nancy France Groupe choc, INSERM U1116, Nancy, France
  3. 3 F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
  4. 4 France Inserm, CIC-1433 Epidemiologie Clinique, Nancy, France
  5. 5 University Hospital of Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France
  6. 6 Intensive Care Unit, University Hospital of Nancy, Nancy, France
  7. 7 Biochimie, Biologie moléculaire, Nutrition, Métabolisme, Hôpital de Brabois, CHRU Nancy, Nancy, France
  8. 8 Hématologie, Hôpital de Brabois, CHRU Nancy, Nancy, France
  9. 9 Pôle de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU Nancy, Nancy, France
  1. Correspondence to Dr Tahar Chouihed; t.chouihed{at}


Objectives To assess the prognostic value of hyponatraemia, hyperglycaemia and impaired estimated glomerular filtration rate (eGFR) in predicting in-hospital death in patients with acute heart failure (AHF) admitted for acute dyspnoea in the emergency department.

Design Retrospective observational study.

Setting Emergency Department of the University Hospital of Nancy. Data were collected from August 2013 to October 2015.

Participants The analysis included 405 patients with AHF admitted for acute dyspnoea in an emergency department.

Results The population was elderly (mean age 82 years), 20.1% had hyponatraemia, 45.1% had hyperglycaemia and 48.6% had eGFR <50 mL/min/1.73 m2. Sixty-one patients (15.1%) died in hospital, mostly due to cardiac aetiology (58.3%). In multivariable analysis adjusted for key potential confounders, adjusted hyponatraemia (OR=2.40, (1.16 to 4.98), p=0.02), hyperglycaemia (OR=2.00, 1.06 to 3.76, p=0.03) and eGFR <50 mL/min/1.73 m2 (OR=1.97 (1.00 to 3.80), p=0.04*) were all identified as significant independent predictors of in-hospital death.

Conclusions Results of basic routine laboratory tests (hyponatraemia, hyperglycaemia and impaired eGFR) performed on admission in the emergency department are independently associated with in-hospital death. These inexpensive tests, performed as early as patient admission in the emergency department, could allow the early identification of patients admitted for AHF who are at high risk of in-hospital death.

Trial registration number NCT02800122.

  • mortality predictors
  • acute heart failure
  • basic laboratory test parameters
  • emergency department

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  • Contributors TC, ABu, ABa, DJ, PR, FZ and NG drafted the manuscript for important intellectual content. LN provided the study clinical data. ABu and JMV coordinated the data management and performed the data analysis. FB and SS coordinated the biological analysis dataset. All authors read and approved the final manuscript.

  • Funding Results incorporated in this article received funding from the Investments for the Future program under grant agreement No ANR-15-RHU-0004.

  • Competing interests TC and NG have received Board Membership Fees from Novartis. PR received fees from Relypsa. FZ has received fees for serving on the board of Boston Scientific; consulting fees from Novartis, Takeda, AstraZeneca, Boehringer Ingelheim, GE Healthcare, Relypsa, Servier, Boston Scientific, Bayer, Johnson and Johnson, and Resmed; and speakers’ fees from Pfizer and AstraZeneca. FZ and PR are co-founders of CardioRenal diagnostics.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval In keeping with data protection requirements, the PARADISE "Pathway of dyspneic patients in Emergency" cohort was approved by the Commission d’Informatique et Libertés (CIL) under number: R2016-08.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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