What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute Decompensated Heart Failure (n=1359). Intervention: High urine sodium vs. Low urine sodium. Primary outcome: Mortality (OR 0.28, 95% CI 0.12-0.68, p=0.005).

What question did this study set out to answer?

Evaluate the prognostic value of urine sodium in clinical outcomes for acute decompensated heart failure patients treated with diuretics.

June 12, 2026Cureus0 citationsOpen Access

Prognostic Value of Urine Sodium in Patients With Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis

MIMuftawu-Deen iddrisuCleveland Clinic Florida EREsteban Rodriguez XLXigmara Martinez Leyva

Key Result

High urine sodium measured within six hours of diuretic administration in patients with acute decompensated heart failure was associated with a 72% reduction in the odds of mortality (OR 0.28) compared with low urine sodium.

Key Points

Evaluate the prognostic value of urine sodium in clinical outcomes for acute decompensated heart failure patients treated with diuretics.
Systematic review and meta-analysis of studies from MEDLINE, Cochrane, and Embase
Included 1,359 patients from eight studies comparing high and low urine sodium
Primary outcomes included mortality, length of stay, inotrope use, and renal function.
High urine sodium associated with lower mortality (OR, 0.28; 95% CI, 0.12-0.68)
Reduced inotrope use (OR, 0.40; 95% CI, 0.25-0.62)
Shorter length of stay (mean difference, -4.35; 95% CI, -7.88 to -0.81)

Study Design

Type

Meta-Analysis (n=1,359)

Structured PICO

Does high spot urine sodium predict reduced mortality, length of stay, inotrope use, and worsening renal function in adult patients admitted for acute decompensated heart failure treated with diuretics?

Population

1,359 adult patients admitted for acute decompensated heart failure who had spot urine sodium measured after the first void or within six hours of diuretic administration.

Exposure

High spot urine sodium (cutoffs ranging from 50 to 113 mEq/L) measured after the first void or within six hours of diuretic administration

Comparator

Low spot urine sodium

Outcome

Mortality, length of hospitalization/stay (LOS), inotrope use, and worsening renal functionhard clinical

In patients with acute decompensated heart failure, high spot urine sodium within six hours of diuretic therapy is associated with significantly lower mortality, shorter length of stay, and reduced need for inotropes.

Main Result

Odds Ratio: 0.28 (95% CI 0.12–0.68)

p-value: p=0.005

Limitations

Most included studies were observational and single-center in design
Marked variability in the cutoff values used to define low and high urinary sodium (ranging from 50 to 113 mEq/L)
Spot urine collection methods were not standardized across studies
Unmeasured confounding such as dietary salt intake and concomitant medications
SGLT2i use was not addressed in the included studies
Predominantly European and East Asian study populations

Abstract

Acute decompensated heart failure (ADHF) remains a leading cause of hospitalization worldwide. The prognostic value of spot urinary sodium concentration in determining clinical outcomes for patients with ADHF treated with diuretics remains uncertain. This systematic review with meta-analysis was registered in the International Prospective Register of Systematic Reviews (CRD42024626912). MEDLINE, Cochrane, and Embase were searched from inception to May 2026 for studies comparing high and low urine sodium, measured after the first void or within six hours of diuretic use, in adult patients admitted for ADHF. The primary outcomes of interest were mortality, length of hospitalization/stay (LOS), inotrope use, and worsening renal function. Odds ratios (ORs) with 95% confidence intervals (CI) were pooled with a random-effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations. A total of eight studies comprising 1,359 patients were included in the meta-analysis, of which 923 (67.9%) were categorized in the high urinary sodium group and 464 (32.1%) in the low urinary sodium group. In patients with ADHF, high urine sodium was associated with lower mortality (OR, 0.28; 95% CI, 0.12-0.68), reduced inotrope use (OR, 0.40; 95% CI, 0.25-0.62), lower worsening renal function (OR, 0.53; 95% CI, 0.32-0.86), and shorter LOS (mean difference, -4.35; 95% CI, -7.88 to -0.81) compared with low urine sodium. In patients with ADHF treated with diuretics, high urine sodium is associated with improved outcomes, including reduced mortality, inotrope use, worsening renal function, and shorter LOS, compared with patients with low urine sodium.

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