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

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.