Abstract: PO1443
Unraveling the Role of Serum Chloride Level as a Strong Predictor of Outcomes in Patients with Heart Failure: A Systematic Review and Meta-Analysis
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolyte, and Acid-Base Disorders
- 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Jain, Ankur, University of Florida, Gainesville, Florida, United States
- Kallahalli Jayaramu, Shriharsha, University of Florida, Gainesville, Florida, United States
- Koratala, Abhilash, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Kazory, Amir, University of Florida, Gainesville, Florida, United States
Background
The field of heart failure (HF) is conventionally sodium-centric. Low serum sodium concentration has long been recognized as an established marker of adverse outcomes and is commonly included in HF risk prediction models. Not only could the mechanisms leading to hyponatremia result in concurrent hypochloremia, but chloride also has distinct biological roles (e.g. modulating renin secretion) that are relevant in HF. We sought to explore the impact of hypochloremia on the outcomes of patients with a HF.
Methods
This is a PRISMA-guided systematic literature review and meta-analysis (registered in PROSPERO). We searched PubMed, Cochrane, and Embase databases from January 2010 to March 2020 for clinical trials exploring relationship between serum chloride and the outcomes of HF patients. A cumulative analysis of Hazard Ratios (HR) with 95% confidence intervals (CIs) was done using comprehensive meta-analysis software.
Results
A total of 9 studies with 15,979 patients were eligible for analysis; 5 had patients with systolic HF, 3 with both systolic and diastolic HF, and 1 with diastolic HF only. These studies reported HR for risk of mortality with change in serum chloride levels stratified by unit, standard deviation, or predefined groups, and adjusted for serum sodium and a variety of potential confounders. On cumulative analysis we found that serum chloride levels are inversely associated with risk of long-term mortality HR 0.92 (95% CI 0.77 - 0.96; p<0.01).
Conclusion
Based on the data from currently available studies, we identified low serum chloride level as a strong independent predictor of mortality in various phenotypes of HF. While it remains to be elucidated whether it represents a marker of disease severity or reflects an actual pathogenetic mechanism, our results suggest that inclusion of serum chloride in HF risk models is likely to improve their predictive value.