Department of Biomedical Sciences, Humanitas University, Pieve Emanuele.
IRCCS Humanitas Research Hospital, Rozzano, Milan.
J Cardiovasc Med (Hagerstown). 2024 Jul 1;25(7):499-510. doi: 10.2459/JCM.0000000000001644. Epub 2024 May 28.
Electrolyte imbalances are common in patients with heart failure. Several studies have shown that a low serum chloride level is associated with adverse outcomes in hospitalized patients with acute heart failure and in outpatients with chronic heart failure. We performed a systematic review and meta-analysis to assess the association of hypochloremia with all-cause mortality in patients with heart failure.
Data search was conducted from inception through 1 February 2023, using the following MeSH terms: ('chloride' OR 'hypochloremia') AND 'heart failure'. Studies evaluating the association between serum chloride and all-cause mortality in patients with heart failure were included. The predefined primary outcome was all-cause mortality. Pooled hazard ratios and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effects model; fixed-effects model and leave-one-out sensitivity analyses were also performed.
A total of 15 studies, involving 25 848 patients, were included. The prevalence of hypochloremia ranged from 8.6 to 31.5%. Follow-up time ranged from 6 to 67 months. Hypochloremia as a categorical variable was associated with an increased risk of all-cause mortality [hazard ratio 1.56; 95% confidence interval (CI) 1.38-1.75; P < 0.001]. As a continuous variable, serum chloride was associated with all-cause mortality (hazard ratio per mmol/l decrease in serum chloride: 1.06; 95% CI 1.05-1.07; P < 0.001). Results were confirmed by using several sensitivity analyses.
Hypochloremia exhibits a significant prognostic value in patients with heart failure. Serum chloride can be used as an effective tool for risk stratifying in patients with heart failure.
电解质失衡在心力衰竭患者中很常见。几项研究表明，血清氯水平低与住院急性心力衰竭患者和慢性心力衰竭门诊患者的不良预后相关。我们进行了系统评价和荟萃分析，以评估低氯血症与心力衰竭患者全因死亡率的关系。
从研究开始到 2023 年 2 月 1 日进行数据检索，使用以下 MeSH 术语：（“氯”或“低氯血症”）和“心力衰竭”。纳入评估血清氯与心力衰竭患者全因死亡率之间关系的研究。预设的主要结局是全因死亡率。使用随机效应模型计算并汇总风险比和 95%置信区间（CI）作为效应估计值；还进行了固定效应模型和逐一剔除敏感性分析。
共纳入 15 项研究，涉及 25848 名患者。低氯血症的患病率为 8.6%至 31.5%。随访时间为 6 至 67 个月。低氯血症作为分类变量与全因死亡率增加相关[风险比 1.56；95%置信区间（CI）1.38-1.75；P<0.001]。作为连续变量，血清氯与全因死亡率相关（血清氯每降低 1mmol/L 的风险比：1.06；95%CI 1.05-1.07；P<0.001）。通过几种敏感性分析证实了结果。
低氯血症在心力衰竭患者中具有显著的预后价值。血清氯可作为心力衰竭患者风险分层的有效工具。
