Justin L Grodin1, Jennifer Simon2, Rory Hachamovitch1, Yuping Wu3, Gregory Jackson4, Meghana Halkar5, Randall C Starling1, Jeffrey M Testani6, W H Wilson Tang7. 1. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 2. Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut. 3. Department of Mathematics, Cleveland State University, Cleveland, Ohio. 4. Department of Medicine, Cardiovascular Division, Medical University of South Carolina, Charleston, South Carolina. 5. Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio. 6. Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut. Electronic address: jeffrey.testani@yale.edu. 7. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department for Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, Ohio. Electronic address: tangw@ccf.org.
Abstract
BACKGROUND: Acute decompensated heart failure (ADHF) can be complicated by electrolyte abnormalities, but the major focus has been concentrated on the clinical significance of serum sodium levels. OBJECTIVES: This study sought to determine the prognostic significance of serum chloride levels in relation to serum sodium levels in patients with ADHF. METHODS: We reviewed 1,318 consecutive patients with chronic heart failure admitted for ADHF to the Cleveland Clinic between July 2008 and December 2013. We also validated our findings in an independent ADHF cohort from the University of Pennsylvania (n = 876). RESULTS: Admission serum chloride levels during hospitalization for ADHF were independently and inversely associated with long-term mortality (hazard ratio [HR] per unit change: 0.94; 95% confidence interval [CI]: 0.92 to 0.95; p < 0.001). After multivariable risk adjustment, admission chloride levels remained independently associated with mortality (HR per unit change: 0.93; 95% CI: 0.90 to 0.97; p < 0.001) in contrast to admission sodium levels, which were no longer significant (p > 0.05). Results were similar in the validation cohort in unadjusted (HR per unit change for mortality risk within 1 year: 0.93; 95% CI: 0.91 to 0.95; p < 0.001) and multivariable risk-adjusted analysis (HR per unit change for mortality risk within 1 year: 0.95; 95% CI: 0.92 to 0.99; p = 0.01). CONCLUSIONS: These observations in a contemporary advanced ADHF cohort suggest that serum chloride levels at admission are independently and inversely associated with mortality. The prognostic value of serum sodium in ADHF was diminished compared with chloride.
BACKGROUND: Acute decompensated heart failure (ADHF) can be complicated by electrolyte abnormalities, but the major focus has been concentrated on the clinical significance of serum sodium levels. OBJECTIVES: This study sought to determine the prognostic significance of serum chloride levels in relation to serum sodium levels in patients with ADHF. METHODS: We reviewed 1,318 consecutive patients with chronic heart failure admitted for ADHF to the Cleveland Clinic between July 2008 and December 2013. We also validated our findings in an independent ADHF cohort from the University of Pennsylvania (n = 876). RESULTS: Admission serum chloride levels during hospitalization for ADHF were independently and inversely associated with long-term mortality (hazard ratio [HR] per unit change: 0.94; 95% confidence interval [CI]: 0.92 to 0.95; p < 0.001). After multivariable risk adjustment, admission chloride levels remained independently associated with mortality (HR per unit change: 0.93; 95% CI: 0.90 to 0.97; p < 0.001) in contrast to admission sodium levels, which were no longer significant (p > 0.05). Results were similar in the validation cohort in unadjusted (HR per unit change for mortality risk within 1 year: 0.93; 95% CI: 0.91 to 0.95; p < 0.001) and multivariable risk-adjusted analysis (HR per unit change for mortality risk within 1 year: 0.95; 95% CI: 0.92 to 0.99; p = 0.01). CONCLUSIONS: These observations in a contemporary advanced ADHF cohort suggest that serum chloride levels at admission are independently and inversely associated with mortality. The prognostic value of serum sodium in ADHF was diminished compared with chloride.
Authors: Justin L Grodin; Frederik H Verbrugge; Stephen G Ellis; Wilfried Mullens; Jeffrey M Testani; W H Wilson Tang Journal: Circ Heart Fail Date: 2016-01 Impact factor: 8.790
Authors: Justin L Grodin; Jie-Lena Sun; Kevin J Anstrom; Horng H Chen; Randall C Starling; Jeffrey M Testani; W H Wilson Tang Journal: Am J Cardiol Date: 2016-09-30 Impact factor: 2.778
Authors: Jennifer S Hanberg; Veena Rao; Jozine M Ter Maaten; Olga Laur; Meredith A Brisco; F Perry Wilson; Justin L Grodin; Mahlet Assefa; J Samuel Broughton; Noah J Planavsky; Tariq Ahmad; Lavanya Bellumkonda; W H Wilson Tang; Chirag R Parikh; Jeffrey M Testani Journal: Circ Heart Fail Date: 2016-08 Impact factor: 8.790
Authors: Tawfeq Naal; Batool Abuhalimeh; Ghaleb Khirfan; Raed A Dweik; W H Wilson Tang; Adriano R Tonelli Journal: Chest Date: 2018-04-24 Impact factor: 9.410
Authors: Jeffrey M Testani; Jennifer S Hanberg; Juan Pablo Arroyo; Meredith A Brisco; Jozine M Ter Maaten; F Perry Wilson; Lavanya Bellumkonda; Daniel Jacoby; W H Wilson Tang; Chirag R Parikh Journal: Eur J Heart Fail Date: 2016-01-13 Impact factor: 15.534