Soni Jinit R, Marrapu Sudheer, Kumar Ramesh
Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India.
World J Hepatol. 2025 Mar 27;17(3):103807. doi: 10.4254/wjh.v17.i3.103807.
Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels. In such patients, hyponatremia has been identified as a predictor of poor outcomes. However, emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations. Hypochloremia, characterised by low serum chloride levels, has been linked to increased mortality, exacerbated organ dysfunction, and higher requirements for renal replacement therapy and vasopressors in various critical conditions, including advanced liver diseases. The pathophysiological mechanisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electrolyte imbalances, renal function, and systemic hemodynamics. Chloride dysregulation can influence renal salt-sensing mechanisms, disrupt acid-base homeostasis, and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome. This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease. By reviewing recent literature and analysing clinical data, we seek to establish serum chloride as an underutilised but valuable prognostic marker. Understanding the role of serum chloride in liver disease could enhance prognostic accuracy, refine treatment strategies, and ultimately improve patient outcomes.
晚期肝硬化和肝衰竭患者的血清电解质水平常常出现异常。在这类患者中，低钠血症已被确定为预后不良的一个预测指标。然而，新出现的证据表明，在类似情况下血清氯化物可能能提供更好的预后信息。以血清氯化物水平低为特征的低氯血症，在包括晚期肝病在内的各种危急情况下，与死亡率增加、器官功能障碍加重以及对肾脏替代治疗和血管加压药的更高需求有关。血清氯化物水平低与肝病预后不良之间关联的病理生理机制似乎涉及电解质失衡、肾功能和全身血流动力学之间的复杂相互作用。氯化物调节异常可影响肾脏的盐感知机制，破坏酸碱平衡，并加重肝性脑病和肝肾综合征等并发症。本文旨在阐明晚期肝病患者血清氯化物水平降低的预后意义。通过回顾近期文献并分析临床数据，我们试图将血清氯化物确立为一种未得到充分利用但有价值的预后标志物。了解血清氯化物在肝病中的作用可以提高预后准确性，优化治疗策略，并最终改善患者预后。
