The Effects Of Different Serum Chloride Levels On Long-term Prognosis Of Patients With Heart Failure

Objectives To investigate the effect of different serum chloride level on the prognosis of patients with heart failure,and compared serum sodium and serum chloride in predicting the prognosis of patients with heart failure.Methods From February 2017 to January 2018,344 patients with heart failure were enrolled in the Department of Cardiology of Hebei People's hospital.According to the serum chloride level at admission,the patients divided into the <103mmol/L group(n=123),103-105mmol/L group(n=101),and >105mmol/L group(n=120)by the tertiles,analyzed baseline data of three groups of patients.After a median follow-up of 522 days,Kaplan-Meier analysis was performed on the three groups of patients,and COX proportional hazards model was established with all-cause mortality occurring during follow-up as the primary endpoint.Pearson test was used to analyze the correlation between serum sodium and serum chloride,and the receiver operating characteristic(ROC)curve was drawn to compare the ability of serum sodium and serum chloride to distinguish allcause mortality events.Results A total of 106 cases(30.8%)of all-cause mortality occurred during the followup period.Compared with the 103-105mmol/L group(21.8%)and the >105mmol/L group(20%),the all-cause mortality(48.8%)in the < 103mmol/L group was significantly higher.Univariate COX proportional hazards model showed that decreased of serum sodium(HR=0.948,95%CI:0.906-0.992,P<0.05)and decreased of serum chloride(HR=0.93,95%CI:0.896-0.966,P<0.05)were all associated with all-cause mortality in patients with heart failure.However,in multivariable COX proportional hazards models including age,diabetes history,glomerular filtration rate,and hemoglobin,serum chloride were still associated with all-cause mortality in patients with heart failure(HR=0.908,95%CI:0.859-0.961,P<0.05).However,there were no statistical differences between the decrease of serum sodium and all-cause mortality in heart failure patients.Pearson correlation analysis showed a moderate correlation between serum sodium and serum chloride(r=0.682).The receiver operating characteristic(ROC)curve of serum sodium and serum chloride showed that the sensitivity of sodium was 0.761,the specificity was 0.387,the area under the curve was 0.584,and the optimal threshold was 137.5.The sensitivity of chloride was 0.735,the specificity was 0.566,the area under the curve was 0.649,and the optimal critical value was 102.5.Conclusions 1 Compared with serum sodium,serum chloride has better ability to distinguish the prognosis of patients with heart failure.2 Decreased of serum chloride levels are an independent risk factor for all-cause mortality in patients with heart failure.Serum chloride and serum sodium were moderately correlated in patients with heart failure.Figure3,Table2,Reference 163...