Original article| Volume 84, P32-37, February 2021

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Baseline and incident hypochloremia in chronic heart failure outpatients: Clinical correlates and prognostic role

Published:September 05, 2020DOI:


      • 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.



      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.


      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.


      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).


      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.


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