Maria Consiglia Bellino1, Francesco Massari2, Miriam Albanese1, Raffaella Ursi1, Gianmarco Angelini1, Francesco Lisi1, Luca Amato3, Pietro Scicchitano2, Pietro Guida4, Natale Daniele Brunetti5, Francesca Di Serio6, Marco Matteo Ciccone1, Massimo Iacoviello7. 1. School of Cardiology, "A. Moro" University of Bari, Bari, Italy; University Cardiology Unit, University Policlinic Hospital of Bari, Bari, Italy. 2. Cardiology Unit, Perinei Hospital, Altamura, Italy. 3. School of Cardiology, "A. Moro" University of Bari, Bari, Italy. 4. Miulli Hospital, Acquaviva delle Fonti, Italy. 5. Cardiology Unit, Department of Medical and Surgical Science, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy. 6. Clinical Pathology Unit, University Policlinic Hospital of Bari, Bari, Italy. 7. Cardiology Unit, Department of Medical and Surgical Science, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy. Electronic address: massimo.iacoviello@unifg.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.
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 patientsdied 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.
Authors: Raffaella Ursi; Francesco Pesce; Miriam Albanese; Vittoria Pavone; Dario Grande; Marco M Ciccone; Massimo Iacoviello Journal: Hemodial Int Date: 2022-04-13 Impact factor: 1.543