Serum Chloride Level as a Prognostic Indicator in Acute Decompensated Heart Failure

Abstract

BACKGROUND: Chloride plays a critical role in plasma electroneutrality, acid-base homeostasis, and the stimulation of neurohormone systems like the RAAS. The effects of serial changes in serum chloride, however, on morbidity and mortality in ADHF patients during hospitalisation have not been thoroughly documented. Diuretics are recommended in clinical guidelines for the treatment of HF, however not to reduce mortality but rather to lessen symptoms and hospitalizations. The mainstay of the early management of acute HF is systemic diuretic decongestion. Due to the increase of sodium and water uptake in the loop of Henle, low blood chloride levels can result in impaired diuretic response. With these factors in mind, this study was carried out to determine the relationship between serum sodium levels and the influence of admission serum chloride concentrations on the length of hospital stay in HF patients. OBJECTIVES: To study the impact of admission Sr. Chloride levels on stay duration in ADHF and to assess the outcome, morbidity, mortality in patients presenting with ADHF. METHODS: This study was conducted as observational cross sectional study in the department of General medicine in Thanjavur Medical College among cases with ADHF during November 2021 to August 2022. A total of 170 cases with ADHF were included in the study. Ethical committee approval was obtained for this study from the Institutional Human Ethics Committee Principal investigator assessed the detailed history of the participants and clinical examination was done. Sr. electrolytes were done on the patients on the day of their admission. Patients are followed up till discharge from the hospital and assessment was done on stay duration in hospital, mortality outcomes also assessed in association with Sr. Cholride level. The data was entered in excel sheet and analyzed using SPSS (Version 19). RESULTS: In the present study among the study participants Dilated CM was diagnosed among 31.8% of the study cases while 50.6% of the cases had Ischemic CM. Chloride level at the time of admission was noted to be 101 meq/L among 27.6%, 52.4% and 20% of the cases respectively in this study. On assessing the difference between admission serum Cl levels with other clinical parameters, age, SBP, DBP, Serum Sodium, LVEF, duration of stay in hospital and mortality were found to be significantly differs with serum chloride levels where as the parameters like gender, BMI, presence of DM, hypertension, dyslipidemia, previous history of MI, CKD, COPD, habit of amoking, alcohol consumption, medications, type of cardiomyopathy, Hemoglobin, Serum Urea, Serum Creatinine, Serum potassium and AF were found to be similar in all groups of serum chloride without any significant difference. CONCLUSION: We conclude that admission serum chloride among the cases with ADHF had a strong impact on the prognosis and duration of hospital stay. Hence it is important to assess the serum chloride levels during the time of admission, with which we can assess the likely duration of hospital stay and the prognosis also