Department of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing 100037, China.
Department of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing 100037, China.
Clin Chim Acta. 2018 Aug;483:112-118. doi: 10.1016/j.cca.2018.04.028. Epub 2018 Apr 21.
Serum chloride concentrations have clinical significance in the prognosis of heart failure (HF). Little is known regarding the prognostic value of serum chloride in patients with chronic heart failure (CHF). This study sought to investigate the prognostic ability of admission serum chloride for long-term mortality in CHF patients.
We identified 1021 consecutive patients diagnosed with CHF. Participants were followed up for all-cause mortality at 21 ± 9 months to establish the survival models and analyze the association between admission serum chloride concentrations and death risk.
Of the 1021 patients, 905(88.6%) available cases were obtained. Admission serum chloride concentrations of patients were independently and inversely associated with long-term mortality (hazard ratio [HR]: 0.890; 95% CI: 0.863 to 0.918; p < 0.001). After multivariable risk adjustment for age, male sex, history of diabetes, LVEF, loop diuretic use, beta-blocker use, ACEI or ARB use, eGFR and NT-proBNP, chloride concentrations remained independently associated with mortality (HR:0.922; 95% CI:0.887 to 0.958; p < 0.001) but not independent of sodium concentrations (HR: 0.953; 95% CI: 0.900 to 1.009; p = 0.095). The optimal cut-off value of chloride concentrations predicting death was 102.8 mmol/l with an area under the curve (AUC) value of 0.686 (95% CI: 0.635 to 0.737; p < 0.001), with a sensitivity of 62% and specificity of 70%. The lower chloride concentrations could significantly increase the risk ratio of CHF patients in the setting of hyponatremia (p < 0.001). The cumulative survival estimates significantly differed across Na/Cl quartiles (log-rank χ 19.14, p < 0.001), with higher mortality for higher Na/Cl ratio. Correlation analysis showed a positive correlation between serum chloride concentrations and sodium concentrations (r = 0.598; p < 0.001). An increased AUC was observed by combining chloride and sodium (AUC = 0.704, 95% CI:0.655-0.754, p < 0.001) compared to sodium only (AUC = 0.689, 95% CI:0.639-0.739, p < 0.001).
In a Chinese Han population, admission serum chloride concentrations are inversely associated with all-cause mortality of CHF patients and provide incremental prognostic information of serum sodium.
血清氯浓度在心力衰竭（HF）的预后中有临床意义。关于慢性心力衰竭（CHF）患者血清氯的预后价值知之甚少。本研究旨在探讨入院时血清氯对 CHF 患者长期死亡率的预测能力。
我们确定了 1021 例连续诊断为 CHF 的患者。在 21±9 个月时对所有患者进行了全因死亡率的随访，以建立生存模型并分析入院时血清氯浓度与死亡风险之间的关系。
在 1021 例患者中，905（88.6%）例可获得可用病例。入院时的血清氯浓度与长期死亡率呈独立的负相关（危险比[HR]：0.890；95%置信区间：0.863 至 0.918；p<0.001）。在对年龄、男性、糖尿病史、LVEF、袢利尿剂使用、β受体阻滞剂使用、ACEI 或 ARB 使用、eGFR 和 NT-proBNP 进行多变量风险调整后，氯浓度与死亡率仍呈独立相关（HR：0.922；95%置信区间：0.887 至 0.958；p<0.001），但与钠浓度无关（HR：0.953；95%置信区间：0.900 至 1.009；p=0.095）。预测死亡的氯浓度最佳截断值为 102.8mmol/l，曲线下面积（AUC）值为 0.686（95%置信区间：0.635 至 0.737；p<0.001），灵敏度为 62%，特异性为 70%。在低钠血症的情况下，较低的氯浓度可显著增加 CHF 患者的风险比（p<0.001）。钠/氯四分位数的累积生存估计值差异有统计学意义（对数秩 χ 19.14，p<0.001），钠/氯比值越高，死亡率越高。相关性分析显示，血清氯浓度与钠浓度呈正相关（r=0.598；p<0.001）。与仅使用钠（AUC=0.689，95%CI：0.639-0.739，p<0.001）相比，联合使用氯和钠时观察到 AUC 增加（AUC=0.704，95%CI：0.655-0.754，p<0.001）。
在中国汉族人群中，入院时血清氯浓度与 CHF 患者的全因死亡率呈负相关，并提供血清钠的额外预后信息。
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