Division of Cardiology, Osaka General Medical Center.
Division of Cardiovascular Medicine, Osaka University Graduate School of Medicine.
Circ J. 2018 Mar 23;82(4):1041-1050. doi: 10.1253/circj.CJ-17-0938. Epub 2018 Feb 22.
Although hyponatremia predicts morbidity and mortality in acute decompensated heart failure (ADHF), hypochloremia is also independently associated with poor prognosis in ADHF. Little is known, however, about the prognostic value of serial change in serum chloride during hospitalization in ADHF patients.
We prospectively studied 208 ADHF survivors after discharge and divided them into 4 groups according to serum chloride on admission and at discharge: (1) persistent hypochloremia group (n=12), hypochloremia both on admission and at discharge; (2) progressive hypochloremia group (n=42), development of hypochloremia after admission; (3) improved hypochloremia group (n=14), hypochloremia only on admission; and (4) no hypochloremia group, no hypochloremia during hospitalization (n=140). During a mean follow-up period of 1.86±0.76 years, 20 of 208 patients had heart failure death (HFD). In a model adjusted for hyponatremia, hypochloremia both on admission and at discharge was still significantly associated with HFD. Hyponatremia, however, was not significantly associated with HFD after adjustment for hypochloremia. Patients with persistent hypochloremia (HR, 9.13; 95% CI: 2.56-32.55) and with progressive hypochloremia (HR, 4.65; 95% CI: 1.61-13.4) had a significantly greater risk of HFD than those without hypochloremia during hospitalization.
Both persistent hypochloremia and progressive hypochloremia during hospitalization are associated with HFD in ADHF patients.
尽管低钠血症可预测急性失代偿性心力衰竭（ADHF）的发病率和死亡率，但低氯血症也与 ADHF 预后不良独立相关。然而，关于 ADHF 患者住院期间血清氯连续变化的预后价值知之甚少。
我们前瞻性研究了 208 例 ADHF 幸存者出院后，并根据入院时和出院时的血清氯将他们分为 4 组：（1）持续性低氯血症组（n=12），入院和出院时均存在低氯血症；（2）进行性低氯血症组（n=42），入院后出现低氯血症；（3）改善性低氯血症组（n=14），仅入院时存在低氯血症；（4）无低氯血症组，住院期间无低氯血症（n=140）。在平均 1.86±0.76 年的随访期间，208 例患者中有 20 例发生心力衰竭死亡（HFD）。在调整低钠血症的模型中，入院时和出院时的低氯血症与 HFD 仍显著相关。然而，在调整低氯血症后，低钠血症与 HFD 无显著相关性。与住院期间无低氯血症的患者相比，持续性低氯血症（HR，9.13；95%CI：2.56-32.55）和进行性低氯血症（HR，4.65；95%CI：1.61-13.4）的 HFD 风险显著增加。
ADHF 患者住院期间持续性低氯血症和进行性低氯血症均与 HFD 相关。
