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Hypochloraemia is strongly and independently associated with mortality in patients with chronic heart failure.

ABSTRACT: Hyponatraemia is strongly associated with adverse outcomes in heart failure. However, accumulating evidence suggests that chloride may play an important role in renal salt sensing and regulation of neurohormonal and sodium-conserving pathways. Our objective was to determine the prognostic importance of hypochloraemia in patients with heart failure.Patients in the BEST trial with baseline serum chloride values were evaluated (n?=?2699). Hypochloraemia was defined as a serum chloride ?96?mmol/L and hyponatraemia as serum sodium ?135?mmol/L. Hypochloraemia was present in 13.0% and hyponatraemia in 13.7% of the population. Chloride and sodium were only modestly correlated (r?=?0.53), resulting in only 48.7% of hypochloraemic patients having concurrent hyponatraemia. Both hyponatraemia and hypochloraemia identified a population with greater disease severity; however, renal function tended to be worse and loop diuretic doses higher with hypochloraemia. In univariate analysis, lower serum sodium or serum chloride as continuous parameters were each strongly associated with mortality (P?

SUBMITTER: Testani JM

PROVIDER: S-EPMC5471359 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Hypochloraemia is strongly and independently associated with mortality in patients with chronic heart failure.

Testani Jeffrey M JM Hanberg Jennifer S JS Arroyo Juan Pablo JP Brisco Meredith A MA Ter Maaten Jozine M JM Wilson F Perry FP Bellumkonda Lavanya L Jacoby Daniel D Tang W H Wilson WH Parikh Chirag R CR

European journal of heart failure 20160113 6

<h4>Aims</h4>Hyponatraemia is strongly associated with adverse outcomes in heart failure. However, accumulating evidence suggests that chloride may play an important role in renal salt sensing and regulation of neurohormonal and sodium-conserving pathways. Our objective was to determine the prognostic importance of hypochloraemia in patients with heart failure.<h4>Methods and results</h4>Patients in the BEST trial with baseline serum chloride values were evaluated (n = 2699). Hypochloraemia was ...[more]

PMID: 26763893

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Project description:Outcomes associated with episodes of hypotension while hospitalized with acute decompensated heart failure are not well understood.Using data from Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF), we assessed factors associated with in-hospital hypotension and subsequent 30-day outcomes. Patients were classified as having symptomatic or asymptomatic hypotension. Multivariable logistic regression was used to determine factors associated with in-hospital hypotension, and Cox proportional hazards models were used to assess the association between hypotension and 30-day outcomes. We also tested for treatment interaction with nesiritide on 30-day outcomes and the association between in-hospital hypotension and renal function at hospital discharge. Overall, 1555 of 7141 (21.8%) patients had an episode of hypotension, of which 73.1% were asymptomatic and 26.9% were symptomatic. Factors strongly associated with in-hospital hypotension included randomization to nesiritide (odds ratio, 1.98; 95% confidence interval [CI], 1.76-2.23; P<0.001), chronic metolazone therapy (odds ratio, 1.74; 95% CI, 1.17-2.60; P<0.001), and baseline orthopnea (odds ratio, 1.31; 95% CI, 1.13-1.52; P=0.001) or S3 gallop (odds ratio, 1.21; 95% CI, 1.06-1.40; P=0.006). In-hospital hypotension was associated with increased hazard of 30-day mortality (hazard ratio, 2.03; 95% CI, 1.57-2.61; P<0.001), 30-day heart failure hospitalization or mortality (hazard ratio, 1.58; 95% CI, 1.34-1.86; P<0.001), and 30-day all-cause hospitalization or mortality (hazard ratio, 1.40; 95% CI, 1.22-1.61; P<0.001). Nesiritide had no interaction on the relationship between hypotension and 30-day outcomes (interaction P=0.874 for death, P=0.908 for death/heart failure hospitalization, P=0.238 death/all-cause hospitalization).Hypotension while hospitalized for acute decompensated heart failure is an independent risk factor for adverse 30-day outcomes, and its occurrence highlights the need for modified treatment strategies.http://www.clinicaltrials.gov. Unique identifier: NCT00475852.

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Hypochloraemia is strongly and independently associated with mortality in patients with chronic heart failure.

Publications

Hypochloraemia is strongly and independently associated with mortality in patients with chronic heart failure.

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