engleski

Hypochloraemia as a predictor of developing hyponatraemia and poor outcome in acute heart failure patients

Aims: Heart failure (HF) is a major public health issue currently affecting more than 23 million patients worldwide. Hyponatraemia has been shown to be a predictor of poor outcome in patients with acute and chronic HF. Therefore, we aimed at finding a marker for early detection of patients at risk for developing hyponatraemia. To this end, the present study investigated the relationship between initial serumchloride and follow-up sodium levels in acute heart failure (AHF) patients. Methods and results: The present study was performed as a prospective, single-centre, observational research with a total of 152 hospitalised AHF patients. Compared to patients with initial normochloraemia, patients with initial hypochloraemia had a statistically significantly higher incidence of hyponatraemia after a 3-month follow-up [P b 0.001 ; odds ratio (OR) = 27.08, CI: 4.3–170.7]. A similar finding was obtained upon exclusion of patients with initial hyponatraemiawith Fishers test [P=0.034 ; odds ratio (OR)=15.5, CI:1.7–140.6]. Binary logistic regression revealed a significantly increased in-hospital mortality in the hypochloraemic/ normonatriaemic (OR = 4.08, CI 1.08–15.43, P = 0.039), but not in the hypochloraemic/hyponatraemic, normochloraemic/hyponatraemic or normonatriaemic/normochloraemic patients. Ejection fraction (EF) at admission was significantly higher in hypochloraemic/normonatriaemic, compared to normonatriaemic/ normochloraemic patients, but similar to EF in both hypochloraemic/hyponatraemic and normochloraemic/ hyponatraemic patients. The N- terminal precursor Brain Natriuretic Peptide (Nt-proBNP) levels at admission were significantly lower in hypochloraemic/normonatriaemic compared to hypochloraemic/hyponatraemic and normonatriaemic/normochloraemic patients, respectively. Conclusion: The data show that initial low serum chloride concentration is predictive of developing hyponatraemia and associated with increased in- hospital mortality in AHF patients.

acute heart failure ; hyponatraemia ; hypochloraemia ; survival

This work was supported by the Austrian Science Foundation[P27166-B23 to S.F., and the Jubilee Foundation of the Austrian National Bank [15858 to S.F.]. Acknowledgements: We thank Aleksandra Žmegač Horvat, University of Zagreb School of Medicine, for language editing the text.