Çetin Güvenç Rengin, Güvenç Tolga Sinan, Temizhan Ahmet, Çavuşuğlu Yüksel, Çelik Ahmet, Yılmaz Mehmet Birhan
Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Istanbul Okan University, Istanbul, Turkey.
Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Istinye University, Istanbul, Turkey.
J Investig Med. 2023 Apr;71(4):339-349. doi: 10.1177/10815589221149186. Epub 2023 Jan 20.
Hypochloremia has recently gained interest as a potential marker of outcomes in patients with heart failure (HF). The exact pathophysiologic mechanism linking hypochloremia to HF is unclear but is thought to be mediated by chloride-sensitive proteins and channels located in kidneys. This analysis aimed to understand whether renal dysfunction (RD) affects the association of hypochloremia with mortality in patients with HF. Using data from a nationwide registry, 438 cases with complete data on serum chloride concentration and 1-year survival were included in the analysis. Patients with an estimated glomerular filtration rate of <60 mL/min/m at baseline were accepted as having RD. Hypochloremia was defined as a chloride concentration <96 mEq/L at baseline. For HF patients without RD at baseline, patients with hypochloremia had a significantly higher 1-year all-cause mortality than those without hypochloremia (41.6% vs 13.0%, log-rank p < 0.001) and the association remained significant after multivariate adjustment (odds ratio (OR): 2.55, 95% confidence interval (CI): 1.25-5.21). The evidence supporting the association was very strong in this subgroup (Bayesian Factor (BF): 48.25, log OR: 1.56, 95% CI: 0.69-2.43). For patients with RD at baseline, there was no statistically significant difference for 1-year mortality for patients with or without hypochloremia (36.3% vs 29.7, log-rank p = 0.35) and there was no evidence to support an association between hypochloremia and mortality (BF: 1.18, log OR :0.66, 95% CI: -0.02 to 1.35). In patients with HF, the association between low chloride concentration and mortality is limited to those without RD at baseline.
低氯血症最近作为心力衰竭（HF）患者预后的潜在标志物受到关注。低氯血症与HF之间的确切病理生理机制尚不清楚，但认为是由位于肾脏的氯敏感蛋白和通道介导的。本分析旨在了解肾功能不全（RD）是否会影响低氯血症与HF患者死亡率之间的关联。利用全国性登记处的数据，438例血清氯浓度和1年生存率数据完整的病例纳入分析。基线时估计肾小球滤过率<60 mL/min/m²的患者被视为患有RD。低氯血症定义为基线时氯浓度<96 mEq/L。对于基线时无RD的HF患者，低氯血症患者的1年全因死亡率显著高于无低氯血症患者（41.6%对13.0%，对数秩检验p<0.001），多变量调整后该关联仍显著（比值比（OR）：2.55，95%置信区间（CI）：1.25 - 5.21）。在该亚组中支持该关联的证据非常强（贝叶斯因子（BF）：48.25，对数OR：1.56，95% CI：0.69 - 2.43）。对于基线时有RD的患者，有或无低氯血症患者的1年死亡率无统计学显著差异（36.3%对29.7%，对数秩检验p = 0.35），且没有证据支持低氯血症与死亡率之间存在关联（BF：1.18，对数OR：0.66，95% CI： - 0.02至1.35）。在HF患者中，低氯浓度与死亡率之间的关联仅限于基线时无RD的患者。
