Núñez Julio, Miñana Gema, Villalonga Maria, Asenjo María, Carrera Margarita, Epelde Francisco, Gil Mercè, Chivite David, Contra Anna, Pla Xavi, Casado Jesús, Miró Òscar, de la Espriella Rafael, Testani Jeffrey M, Trullàs Joan Carles
Cardiology Department, Hospital Clínico de Valencia, INCLIVA, Valencia, Spain.
Internal Medicine Department, Hospital Universitari Son Espases, Palma, Spain.
Intern Emerg Med. 2025 May 17. doi: 10.1007/s11739-025-03961-z.
Chloride may play an important role in the pathophysiology of heart failure (HF) as it is associated with HF prognosis and diuretic resistance. This study evaluates the diuretic response across serum chloride in patients admitted with acute heart failure (AHF) and treated with loop and thiazide diuretics. This is a subanalysis of the ALCALOTIC study, a prospective, multicentre, observational cohort study that included 665 patients admitted for AHF at 30 clinical sites in Spain. We analysed 386 patients after excluding those without baseline chloride or in-hospital weight loss data. The endpoint was in-hospital weight loss across the spectrum of baseline serum chloride. Mean age was 82 years and 59% were women. Hypochloraemia (< 96 mmol/L) and hyperchloraemia (> 106 mmol/L) were present in 59 (15%) and 65 (17%), respectively. Compared to those with chloraemia ≥ 96 mmol/L, hypochloraemia was independently associated with smaller weight loss at discharge (β coefficient - 0.78, CI 95%: - 1.53 to - 0.21, p = 0.044). Add-on thiazide to loop diuretics was associated with higher weight loss in the overall population (β Coefficient 1.23, CI 95%: 0.38 to 2.09, p = 0.005). However, a differential between-treatment association was found across serum chloride (p value for interaction = 0.020). Thiazides were associated with a greater weight loss in patients with normo- or hyperchloraemia but not in those with hypochloraemia. Hypochloraemia was associated with a worse diuretic response (measured by weight loss during hospitalization). Treatment with thiazides was associated with a better diuretic response only in patients with normo- and hyperchloraemia but not in those with hypochloraemia.
氯离子可能在心力衰竭（HF）的病理生理学中发挥重要作用，因为它与HF预后及利尿剂抵抗相关。本研究评估了急性心力衰竭（AHF）患者血清氯离子水平与袢利尿剂和噻嗪类利尿剂治疗时利尿反应的关系。这是对ALCALOTIC研究的一项亚分析，该研究为前瞻性、多中心、观察性队列研究，纳入了西班牙30个临床地点因AHF入院的665例患者。我们排除了无基线氯离子或住院体重减轻数据的患者后，分析了386例患者。终点为基线血清氯离子范围内的住院体重减轻情况。平均年龄为82岁，女性占59%。低氯血症（<96 mmol/L）和高氯血症（>106 mmol/L）分别有59例（15%）和65例（17%）。与氯血症≥96 mmol/L的患者相比，低氯血症与出院时体重减轻较小独立相关（β系数 -0.78，95%置信区间：-1.53至-0.21，p = 0.044）。在袢利尿剂基础上加用噻嗪类利尿剂与总体人群体重减轻更多相关（β系数1.23，95%置信区间：0.38至2.09，p = 0.005）。然而，发现血清氯离子水平存在治疗组间差异（交互作用p值 = 0.020）。噻嗪类药物与正常氯血症或高氯血症患者体重减轻更多相关，但与低氯血症患者无关。低氯血症与利尿反应较差（通过住院期间体重减轻衡量）相关。噻嗪类药物治疗仅与正常氯血症和高氯血症患者利尿反应较好相关，而与低氯血症患者无关。
