Gu Wenyi, Zhou Jing, Peng Yunzhu, Cai Hongyan, Wang Huawei, Wan Wen, Li Hongxia, Xu Chenggong, Chen Lixing
Kunming Medical University First Affiliated Hospital.
Int Heart J. 2023;64(4):700-707. doi: 10.1536/ihj.22-734.
Little is known regarding the prognostic value of serum chloride in patients with chronic heart failure (CHF) with different ejection fractions. We sought to determine the postdischarge outcomes associated with lower serum chloride between different CHF types.We reviewed the medical records of 1221 consecutive patients with CHF admitted to the First Affiliated Hospital of Kunming Medical University from January 2017 to October 2021. After excluding patients with in-hospital death, missing follow-up data, missing serum chloride level data, or chronic dialysis therapy, 791 patients were included. Of these patients, 343 had heart failure with reduced ejection fraction (HFrEF; i.e., left ventricular ejection fraction (LVEF) < 40%), and 448 had heart failure with preserved ejection fraction (HFpEF) or heart failure with median ejection fraction (HFmrEF; HFpEF plus HFmrEF; i.e., LVEF ≥40%). Over a median follow-up of 750 days, 344 patients (43.5%) had all-cause mortality. In the univariate analysis, serum sodium and chloride were strongly associated with mortality in both HF subgroups (P < 0.0001). A multivariable model including both serum sodium and chloride showed the highly significant association between serum chloride and survival (P < 0.0001), whereas the association between serum sodium and mortality was not reported (HFpEF plus HFmrEF, hazard ratio (HR) 0.975, 95% confidence interval [CI] 0.942-1.010, P = 0.158; HFrEF, HR 1.007, 95% CI 0.966-1.051, P = 0.734). Kaplan-Meier survival curve analysis revealed a significant difference in mortality risk with decreasing chloride levels in all patients with CHF. The optimal cutoff value of chloride in predicting all-cause mortality was 102.95 mmol/L with area under the curve value of 0.76 [HR 0.760, 95% CI 0.727-0.793, P < 0.0001], sensitivity of 60.2%, and specificity of 78.3%.Lower serum chloride is an independent predictor of death in CHF, regardless of heart failure subtype.
关于血清氯在不同射血分数的慢性心力衰竭（CHF）患者中的预后价值，目前所知甚少。我们试图确定不同类型CHF中血清氯降低与出院后结局之间的关系。我们回顾了2017年1月至2021年10月期间连续入住昆明医科大学第一附属医院的1221例CHF患者的病历。排除院内死亡、随访数据缺失、血清氯水平数据缺失或接受慢性透析治疗的患者后，纳入791例患者。其中，343例为射血分数降低的心力衰竭（HFrEF；即左心室射血分数（LVEF）<40%），448例为射血分数保留的心力衰竭（HFpEF）或射血分数中等的心力衰竭（HFmrEF；HFpEF加HFmrEF；即LVEF≥40%）。在中位随访750天期间，344例患者（43.5%）发生全因死亡。在单因素分析中，血清钠和氯与两个HF亚组的死亡率均密切相关（P<0.0001）。一个同时包含血清钠和氯的多变量模型显示血清氯与生存率之间存在高度显著的关联（P<0.0001），而血清钠与死亡率之间的关联未被报道（HFpEF加HFmrEF，风险比（HR）0.975，95%置信区间[CI]0.942-1.010，P=0.158；HFrEF，HR1.007，95%CI0.966-1.051，P=0.734）。Kaplan-Meier生存曲线分析显示，所有CHF患者中，随着氯水平降低，死亡风险存在显著差异。氯预测全因死亡的最佳截断值为102.95 mmol/L，曲线下面积值为0.76[HR0.760，95%CI0.727-0.793，P<0.0001]，敏感性为60.2%，特异性为78.3%。无论心力衰竭亚型如何，血清氯降低都是CHF患者死亡的独立预测因素。
