School of Cardiology, "A. Moro" University of Bari, Bari, Italy; University Cardiology Unit, University Policlinic Hospital of Bari, Bari, Italy.
Cardiology Unit, Perinei Hospital, Altamura, Italy.
Eur J Intern Med. 2021 Feb;84:32-37. doi: 10.1016/j.ejim.2020.08.021. Epub 2020 Sep 4.
Electrolyte serum disorders are associated with poor outcome in chronic heart failure. The aim of this study sought to identify the main driver of incident hypochloremia in chronic HF (CHF) outpatients and to determine the prognostic value of baseline and incident hypochloremia.
Consecutive CHF outpatients were enrolled and clinical, laboratoristic and echocardiographic evaluations were performed at baseline and repeated yearly in a subgroup of patients. Baseline and incident hypochloremia were evaluated. During an up to 5-year follow-up, all-cause mortality was the primary end-point for outcome.
Among 506 patients enrolled, 120 patients died during follow-up. At baseline, hypochloremia was present in 10% of patients and it was associated with mortality at univariate (HR: 3.25; 95%CI: 2.04-5.18; p<0.001) and at multivariate analysis (HR 2.14; 95%CI: 1.23-3.63; p: 0.005) after correction for well-established CHF prognostic markers. Among patients with repeated evaluations and without baseline hypochloremia, in 13% of these, incident hypochloremia occurred during follow-up and furosemide equivalent daily dose was its first determinant (HR for 1 mg/die: 1.008; 95%CI: 1.004-1.013; p<0.001) at forward stepwise logistic regression analysis. Finally, incident hypochloremia was associated with mortality at univariate (HR: 4.69; 95%CI: 2.69-8.19; p<0.001) as well as at multivariate analysis (HR: 2.97; 95%CI: 1.48-5.94; p: 0.002).
In CHF outpatients baseline and incident hypochloremia are independently associated with all-cause mortality, thus highlighting the prognostic role of serum chloride levels which are generally unconsidered. Future studies should evaluate if the strict monitoring and correction of hypochloremia could exert a beneficial effect on prognosis.
电解质血清紊乱与慢性心力衰竭不良预后相关。本研究旨在确定慢性心力衰竭门诊患者中低氯血症的主要驱动因素，并确定基线和低氯血症的预后价值。
连续入组慢性心力衰竭门诊患者，在基线时进行临床、实验室和超声心动图评估，并在部分患者中每年重复评估。评估基线和低氯血症的发生情况。在 5 年的随访期间，全因死亡率为主要终点。
在 506 名入组患者中，120 名患者在随访期间死亡。基线时，10%的患者存在低氯血症，单因素分析（HR：3.25；95%CI：2.04-5.18；p<0.001）和多因素分析（HR 2.14；95%CI：1.23-3.63；p：0.005）校正后与死亡率相关，校正了公认的心力衰竭预后标志物。在有重复评估且基线无低氯血症的患者中，13%的患者在随访期间发生低氯血症，而呋塞米等效日剂量是其首要决定因素（每增加 1mg/die 的 HR：1.008；95%CI：1.004-1.013；p<0.001）。最后，单因素分析（HR：4.69；95%CI：2.69-8.19；p<0.001）和多因素分析（HR：2.97；95%CI：1.48-5.94；p：0.002）均显示低氯血症与死亡率相关。
在慢性心力衰竭门诊患者中，基线和低氯血症与全因死亡率独立相关，因此突出了血清氯水平的预后作用，而这些通常是被忽视的。未来的研究应该评估严格监测和纠正低氯血症是否对预后有有益影响。
