Association of early prognosis in patients with chronic heart failure with markers of renal tubulointerstitial dysfunction

Abstract

The glucose-potassium ratio (GPR) and serum sodium levels are robust indicators of renal metabolic and electrolyte imbalances. These markers can be used to assess the severity of cardiovascular disease and predict adverse outcomes. The renal tubulointerstitium plays a leading role in reabsorption of glucose, potassium, and sodium. In patients with chronic heart failure (CHF), not only the renal glomeruli but also tubulointerstitium is affected, that results in cardiorenal syndrome development. Consequently, alterations in GPR and serum sodium levels are expected in these patients. However, the prognostic value of these markers for predicting adverse cardiovascular events in patients with CHF remains insufficiently studied.

The aim. To investigate changes in the glucose-potassium ratio and serum sodium content in patients with chronic heart failure of ischemic origin and preserved left ventricular ejection fraction, and to determine their impact on adverse cardiovascular events during one year of follow-up.

Materials and methods. This study included 57 patients (43.9 % men, n = 25; 56.1 % women, n = 32) with ischemic CHF, stage II A–B, II–IV functional class per NYHA. Among them, 49.1 % (n = 28) had sinus rhythm, and 50.9 % (n = 29) had atrial fibrillation. Patients with sinus rhythm and atrial fibrillation were comparable in age (p = 0.968), height (p = 0.167), weight (p = 0.539), BMI (p = 0.774), and body surface area (p = 0.296). The serum glucose-potassium ratio (GPR) was calculated by dividing the serum glucose level by the serum potassium level. ROC analysis and logistic regression were performed.

Results. Univariate regression analysis demonstrated that an increase in the GPR above 1.1697 was associated with an 11.15-fold increase in the risk of adverse cardiovascular events at the end of the first year of follow up (95 % CI: 1.33–93.50, p = 0.0048). A decrease in serum sodium level below 142.2 mmol/L increased the risk of adverse events by 5.14 times (95 % CI: 1.0027–26.3538, p = 0.03). In a multivariate logistic regression model (p = 0.0019), the combination of elevated GPR and reduced serum sodium potentiated the relative risk of adverse cardiovascular events. GPR increased the risk 11.69-fold (95 % CI: 1.3538–100.9866, p = 0.025), while serum sodium contributed to a 5.45-fold increase (95 % CI: 1.0046–29.5986, p = 0.049).

Conclusions. The combination of elevated GPR and decreased serum sodium level in a multivariable logistic regression model (p = 0.0019) is a powerful prognostic tool for assessing the risk of adverse cardiovascular events in patients with CHF. These biomarkers provide valuable insights for early risk stratification and should be considered in the clinical management of CHF.