CRACKING THE CODE: UNVEILING SERUM CHLORIDE AS A PROGNOSTIC BEACON FOR HEART FAILURE AT A TERTIARY CARE HOSPITAL

Dr. Narendra Parihar, Dr. Pradeep Mital, Dr. Akanksha Bhagora, Dr. Sohan Lal, Dr. Japneet Sidhu, Dr. Pawan Bunkar

Abstract


Introduction: Congestive heart failure is a pathologic state in which abnormal cardiac function results in the failure of the heart to pump blood at the requisite rate for metabolism or to pump blood from an increased filling pressure. Heart failure (HF) is associated with multiple serum electrolyte abnormalities, including hyponatraemia, hypokalaemia, and hypochloraemia besides acid–base disturbances. We aimed to study the effect of admission serum chloride levels on the duration of hospital stay in HF patients and their correlation with serum sodium levels.

Material and Methods: This was a Prospective study conducted in Department of General Medicine, SMS Medical College and attached group of hospitals, Jaipur. Sample of 75 cases was calculated for detailed history of the patients.

Result: In the present study we included 75 patients. The mean age for the study was 59.13 years with 48 male and 27 female patients. patients were grouped into three categories according to serum chloride level. 18 patients were in Group A (Chloride level <96 meq/L), 25 patients were in Group B (Chloride level 96-101 meq/L) and 32 patients were in Group C (Chloride level >101 meq/L). In our study the median duration of stay of patients in ICU in Category A was 17 days whereas, the median duration of stay of patients in ICU in Category B was 11 days and the median duration of stay of patients in ICU in Category C was 7 days.

Conclusion: Hypochloremia has high prevalence in critical ill ICU patients. Admission serum chloride levels are independently and inversely associated with increased duration of stay in acute decompensated heart failure. This effect is independent of the sodium levels at presentation. Although sodium levels are important, more robust prognostic information can be inferred from serum chloride levels.

Keywords


Heart Failure, Chloride levels.

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References


Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017 Apr;3(1):7-11.

Kemp CD, Conte JV. The pathophysiology of heart failure. Cardiovasc Pathol. 2012 Sep-Oct;21(5):365-71.

CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987 Jun 04;316 (23):1429-35.

Fudim M, Hernandez AF, Felker GM. Role of volume redistribution in the congestion of heart failure. J Am Heart Assoc. 2017;6:e006817.

Wald R, Jaber BL, Price LL, Upadhyay A, Madias NE: Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 170: 294–302, 2010.

Krajewski ML, Raghunathan K, Paluszkiewicz SM, Schermer CR, Shaw AD (2015) Meta-analysis of high- versus low- chloride content in perioperative and critical care fluid resuscitation. Br J Surg 102(1):24–36.

Justin L. Grodin et al. Prognostic Role of Serum Chloride Levels in Acute Decompensated Heart Failure. J Am Coll Cardiol. 2015 Aug 11;66(6):659-66.

Abhishek Goyal et al. Admission Serum Chloride Levels as Predictor of Stay Duration in Acute Decompensated Heart Failure. J Assoc Physicians India. 2020 Oct;68(10):34-38.

Crook MA, Velauthar U, Moran L, Griffiths W: Review of investigation and management of severe hyponatraemia in a hospital population. Ann Clin Biochem 36: 158–162, 1999.

Kataoka H. The “chloride theory”, a unifying hypothesis for renal handling and body fluid distribution in heart failure pathophysiology. Med Hypotheses 2017; 104:170-173.


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