| Summary: | Recent studies have demonstrated the prognostic value of spot urinary sodium (UNa<sup>+</sup>) in acutely decompensated chronic HF (ADCHF) patients. However, data on the prognostic role of UNa<sup>+</sup> and spot urinary chloride (UCl<sup>−</sup>) in patients with advanced HF are limited. In the present prospective pilot study, we examined the predictive value of UNa<sup>+</sup> and UCl<sup>−</sup> concentration at baseline, at 2 h and at 24 h after admission for all-cause mortality and HF rehospitalization up to 3 months post-discharge. Consecutive advanced HF patients (n = 30) admitted with ADCHF and aged > 18 years were included in the study. Loop diuretics were administered based on the natriuresis-guided algorithm recommended by the recent HF guidelines. Exclusion criteria were cardiogenic shock, acute coronary syndrome, estimated glomerular filtration rate < 15 mL/min/1.73 m<sup>2</sup>, severe hepatic dysfunction (Child–Pugh category C), and sepsis. UNa<sup>+</sup> at baseline (Area Under the Curve (AUC) = 0.75, 95% Confidence Interval (CI) (0.58–0.93), <i>p</i> = 0.019) and at 2 h after admission (AUC = 0.80, 95% CI: 0.64–0.96, <i>p</i> = 0.005) showed good and excellent discrimination, respectively. UCl<sup>−</sup> at 2 h after admission (AUC = 0.75, 95%CI (0.57–0.93), <i>p</i> = 0.017) demonstrated good discrimination. In the multivariate logistic regression analysis, UNa<sup>+</sup> at 2 h (<i>p</i> = 0.02) and dose of loop diuretics at admission (<i>p</i> = 0.03) were the only factors independently associated with the study outcome. In conclusion, UNa<sup>+</sup> and UCl<sup>−</sup> may have a prognostic role in hospitalized advanced HF patients.
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