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Published on: June 10, 2025
765
Serum Osmolality and Postdischarge Outcomes After Hospitalization for Heart Failure
Muthiah Vaduganathan1, Catherine N Marti2, Robert J Mentz3
1Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts.
The American Journal of Cardiology
|February 7, 2016
Summary
Low serum osmolality at discharge in heart failure (HF) patients predicts higher mortality and readmission. This finding highlights the importance of monitoring osmolality for improved HF patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Serum osmolality can change with neurohormonal activity and treatments in heart failure (HF) patients.
- The clinical significance of serum osmolality in HF has not been well-established.
Purpose of the Study:
- To analyze the association between serum osmolality at discharge and post-discharge outcomes in hospitalized patients with HF and reduced ejection fraction (EF).
Main Methods:
- Post hoc analysis of 3,744 patients from the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan trial.
- Patients were categorized into low (≤284), normal (285-300), and high (≥300 mOsm/kg) serum osmolality groups based on discharge measurements.
- All-cause mortality (ACM) and a composite of cardiovascular death or HF hospitalization were assessed over a median follow-up of 9.9 months.
Main Results:
- Low discharge serum osmolality (≤284 mOsm/kg) was associated with significantly higher ACM (29.3%) and composite endpoint rates (45.6%) compared to normal or high osmolality groups (p=0.04).
- Risk-adjusted analysis revealed that a 15 mOsm/kg decrease in osmolality predicted increased ACM (HR 1.61) and composite endpoint (HR 1.37) specifically within the low osmolality group.
- No significant associations were observed in patients with normal or high discharge osmolality, and tolvaptan treatment did not significantly interact with these findings.
Conclusions:
- Low serum osmolality at discharge is an independent predictor of worse post-discharge mortality and hospital readmission in patients hospitalized with heart failure and reduced ejection fraction.
- Further research is needed to determine the clinical utility of monitoring serum osmolality in this patient population.
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