Highlights
- •Baseline chloride serum levels and hypochloremia were independently associated with an increased risk of mortality and hospitalizations due to acute decompensated heart failure.
- •During follow-up, high baseline diuretic dose was the main determinant of the occurrence of hypochloremia.
- •Also the occurrence of hypochloremia during follow-up was independently associated with a greater risk of death.
- •In our series of chronic heart failure outpatients, low chloride serum levels have been detected in ten percent of available measurements.
- •Hypochloremia was more frequently observed than hyponatremia and showed an independent prognostic value also from it.
Abstract
Background
Electrolyte serum disorders are associated with poor outcome in chronic heart failure.
The aim of this study sought to identify the main driver of incident hypochloremia
in chronic HF (CHF) outpatients and to determine the prognostic value of baseline
and incident hypochloremia.
Methods
Consecutive CHF outpatients were enrolled and clinical, laboratoristic and echocardiographic
evaluations were performed at baseline and repeated yearly in a subgroup of patients.
Baseline and incident hypochloremia were evaluated. During an up to 5-year follow-up,
all-cause mortality was the primary end-point for outcome.
Results
Among 506 patients enrolled, 120 patients died during follow-up. At baseline, hypochloremia
was present in 10% of patients and it was associated with mortality at univariate
(HR: 3.25; 95%CI: 2.04–5.18; p<0.001) and at multivariate analysis (HR 2.14; 95%CI: 1.23–3.63; p: 0.005) after correction for well-established CHF prognostic markers. Among patients
with repeated evaluations and without baseline hypochloremia, in 13% of these, incident
hypochloremia occurred during follow-up and furosemide equivalent daily dose was its
first determinant (HR for 1 mg/die: 1.008; 95%CI: 1.004–1.013; p<0.001) at forward stepwise logistic regression analysis. Finally, incident hypochloremia
was associated with mortality at univariate (HR: 4.69; 95%CI: 2.69–8.19; p<0.001) as well as at multivariate analysis (HR: 2.97; 95%CI: 1.48–5.94; p: 0.002).
Conclusions
In CHF outpatients baseline and incident hypochloremia are independently associated
with all-cause mortality, thus highlighting the prognostic role of serum chloride
levels which are generally unconsidered. Future studies should evaluate if the strict
monitoring and correction of hypochloremia could exert a beneficial effect on prognosis.
Keywords
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Article info
Publication history
Published online: September 05, 2020
Accepted:
August 20,
2020
Received in revised form:
August 9,
2020
Received:
May 7,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
