Hypochloraemia following admission to hospital with heart failure is common and associated with an increased risk of readmission or death: a report from OPERA-HF

Cuthbert, J.J. et al. (2022) Hypochloraemia following admission to hospital with heart failure is common and associated with an increased risk of readmission or death: a report from OPERA-HF. European Heart Journal: Acute Cardiovascular Care, 11(1), pp. 43-52. (doi: 10.1093/ehjacc/zuab097) (PMID:34897402)

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Abstract

Aims: Hypochloraemia is common in patients hospitalized with heart failure (HF) and associated with a high risk of adverse outcomes during admission and following discharge. We assessed the significance of changes in serum chloride concentrations in relation to serum sodium and bicarbonate concentrations during admission in a cohort of 1002 consecutive patients admitted with HF and enrolled into an observational study based at a single tertiary centre in the UK. Methods and results: Hypochloraemia (<96 mmol/L), hyponatraemia (<135 mmol/L), and metabolic alkalosis (bicarbonate >32 mmol/L) were defined by local laboratory reference ranges. Outcomes assessed were all-cause mortality, all-cause mortality or all-cause readmission, and all-cause mortality or HF readmission. Cox regression and Kaplan–Meier curves were used to investigate associations with outcome. During a median follow-up of 856 days (interquartile range 272–1416), discharge hypochloraemia, regardless of serum sodium, or bicarbonate levels was associated with greater all-cause mortality [hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.15–1.79; P = 0.001], all-cause mortality or all-cause readmission (HR 1.26, 95% CI 1.04–1.53; P = 0.02), and all-cause mortality or HF readmission (HR 1.41, 95% CI 1.14–1.74; P = 0.002) after multivariable adjustment. Patients with concurrent hypochloraemia and natraemia had lower haemoglobin and haematocrit, suggesting congestion; those with hypochloraemia and normal sodium levels had more metabolic alkalosis, suggesting decongestion. Conclusion: Hypochloraemia is common at discharge after a hospitalization for HF and is associated with worse outcome subsequently. It is an easily measured clinical variables that is associated with morbidity or mortality of any cause.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Cuthbert, J.J., Brown, O.I., Urbinati, A., Pan, D., Pellicori, P., Dobbs, K., Bulemfu, J., Kazmi, S., Sokoreli, I., Pauws, S.C., Riistama, J.M., Cleland, J.G.F., and Clark, A.L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Heart Journal: Acute Cardiovascular Care
Publisher:Oxford University Press
ISSN:2048-8726
ISSN (Online):2048-8734
Published Online:13 December 2021
Copyright Holders:Copyright © The Author(s) 2021
First Published:First published in European Heart Journal: Acute Cardiovascular Care 11(1): 43-52
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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