University Clinical Hospital, Wroclaw, Poland.
Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
Sci Rep. 2024 Jun 18;14(1):14100. doi: 10.1038/s41598-024-64747-5.
In our retrospective study, we aimed to investigate the relationship between urinary chloride (uCl) and selected clinical and laboratory biomarkers, renal function, and patient outcomes in the acute heart failure (AHF) population. We divided 248 adult patients (≥ 18 years) with AHF into two groups: low uCl (< 115 mmol/L) and high uCl. The mean age of the patient group was 70.2 ± 12.6, and 182 patients were male (73.4%). Clinical endpoints included in-hospital mortality, one-year mortality, and a composite endpoint of one-year mortality and rehospitalization for heart failure. Patients were followed up for at least one year. Relevant clinical and baseline biomarker data were collected, including markers concerning inflammation, liver and kidney function, perfusion and congestion, iron status, cardiac remodeling, gasometry, renin and aldosterone. Low uCl was associated with worse in-hospital outcomes, including higher in-hospital mortality (7.7% vs. 1.4%, p = 0.014), the need for inotropic support (20.19% vs. 2.08%, p ≤ 0.001), worsening of HF during therapy (17.31% vs. 4.86%, p ≤ 0.001), and the need for treatment in an intensive cardiac care unit (33.65% vs. 15.28%, p ≤ 0.001). Low uCl was a significant predictor of one-year mortality (40.4% vs. 16.7%, p < 0.05) and the composite outcome (HR 2.42, 95% CI 1.43-4.08, p < 0.001). In the multivariable analysis, uCl was independently associated with the risk of one-year mortality (HR 0.92, 95% CI 0.87-0.98, p < 0.05) and the composite outcome (HR 0.95, 95% CI 0.92-0.99, p < 0.05). Our findings suggest that low uCl is a marker of more advanced heart failure, activation of the renin-angiotensin-aldosterone system and is related to worse one-year outcomes.
在我们的回顾性研究中，我们旨在探讨尿氯（uCl）与选定的临床和实验室生物标志物、肾功能以及急性心力衰竭（AHF）患者预后之间的关系。我们将 248 名成年 AHF 患者（≥18 岁）分为两组：低 uCl（<115mmol/L）和高 uCl。患者组的平均年龄为 70.2±12.6 岁，182 名男性（73.4%）。临床终点包括院内死亡率、一年死亡率和一年死亡率和心力衰竭再住院的复合终点。患者至少随访一年。收集了相关的临床和基线生物标志物数据，包括炎症、肝肾功能、灌注和充血、铁状态、心脏重构、气体分析、肾素和醛固酮的标志物。低 uCl 与更差的院内结局相关，包括更高的院内死亡率（7.7%比 1.4%，p=0.014）、需要正性肌力支持（20.19%比 2.08%，p≤0.001）、治疗期间 HF 恶化（17.31%比 4.86%，p≤0.001）和需要在重症心脏监护病房治疗（33.65%比 15.28%，p≤0.001）。低 uCl 是一年死亡率（40.4%比 16.7%，p<0.05）和复合结局（HR 2.42，95%CI 1.43-4.08，p<0.001）的显著预测因子。在多变量分析中，uCl 与一年死亡率（HR 0.92，95%CI 0.87-0.98，p<0.05）和复合结局（HR 0.95，95%CI 0.92-0.99，p<0.05）的风险独立相关。我们的研究结果表明，低 uCl 是心力衰竭更严重、肾素-血管紧张素-醛固酮系统激活的标志物，与一年预后更差相关。
