Misumi Kayo, Matsue Yuya, Nogi Kazutaka, Fujimoto Yudai, Kagiyama Nobuyuki, Kasai Takatoshi, Kitai Takeshi, Oishi Shogo, Akiyama Eiichi, Suzuki Satoshi, Yamamoto Masayoshi, Kida Keisuke, Okumura Takahiro, Nogi Maki, Ishihara Satomi, Ueda Tomoya, Kawakami Rika, Saito Yoshihiko, Minamino Tohru
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
J Cardiol. 2025 Mar;85(3):235-240. doi: 10.1016/j.jjcc.2024.08.011. Epub 2024 Aug 31.
Hypochloremia has been suggested as a strong marker of mortality in hospitalized patients with heart failure (HF). This study aimed to clarify whether incorporating hypochloremia into pre-existing prognostic models improved the performance of the models.
We tested the prognostic value of hypochloremia (<97 mEq/L) measured at discharge in hospitalized patients with HF registered in the REALITY-AHF and NARA-HF studies. The primary outcome was 1-year mortality after discharge.
Among 2496 patients with HF, 316 (12.6 %) had hypochloremia at the time of discharge, and 387 (15.5 %) deaths were observed within 1 year of discharge. The presence of hypochloremia was strongly associated with higher 1-year mortality compared to those without hypochloremia (log-rank: p < 0.001), and this association remained even after adjustment for the Get With the Guideline-HF risk model (GWTG-HF), anemia, New York Heart Association (NYHA) classification, and log-brain natriuretic peptide (BNP) [hazard ratio (HR) 1.64; p < 0.001]. Furthermore, adding hypochloremia to the prediction model composed of GWTG-HF + anemia + NYHA class + log-BNP yielded a numerically larger area under the curve (0.740 vs 0.749; p = 0.059) and significant improvement in net reclassification (0.159, p = 0.010).
Incorporating the presence of hypochloremia at discharge into pre-existing risk prediction models provides incremental prognostic information for hospitalized patients with HF.
低氯血症被认为是住院心力衰竭（HF）患者死亡率的一个强有力的标志物。本研究旨在阐明将低氯血症纳入现有的预后模型是否能改善模型的性能。
我们在REALITY-AHF和NARA-HF研究中登记的住院HF患者出院时检测了低氯血症（<97 mEq/L）的预后价值。主要结局是出院后1年的死亡率。
在2496例HF患者中，316例（12.6%）出院时存在低氯血症，出院后1年内观察到387例（15.5%）死亡。与无低氯血症的患者相比，低氯血症的存在与更高的1年死亡率密切相关（对数秩检验：p<0.001），即使在对遵循心力衰竭指南风险模型（GWTG-HF）、贫血、纽约心脏协会（NYHA）分级和对数脑钠肽（BNP）进行校正后，这种关联仍然存在[风险比（HR）1.64；p<0.001]。此外，在由GWTG-HF+贫血+NYHA分级+对数BNP组成的预测模型中加入低氯血症，曲线下面积在数值上更大（0.740对0.749；p=0.059），净重新分类有显著改善（0.159，p=0.010）。
将出院时低氯血症的存在纳入现有的风险预测模型可为住院HF患者提供额外的预后信息。
