血氯水平与老年急性心力衰竭患者短期不良预后的相关研究

Serum chloride levels are associated with poor short-term outcomes in elderly patients with acute heart failure

目的 评估入院血氯水平对老年急性失代偿性心力衰竭(心衰)患者短期预后的影响。方法 对发表在PhysioNet的中国成人住院心衰数据进行回顾性分析。根据血氯三分位数将患者分为T1组(Cl≤100.2 mmol/L,n=604)、T2组(100.3104.8 mmol/L,n=609)。主要终点为90 d全因死亡和心衰再住院复合终点。采用Kaplan-Meier曲线评估终点事件的发生情况,建立Cox回归模型分析终点事件的风险预测因子。结果 Kaplan-Meier分析显示,三组全因死亡和心衰再住院复合风险显著不同(P=0.010);组间心衰再住院风险存在显著差异(P=0.021),但全因死亡风险无显著差异(P=0.470)。多因素调整的Cox模型显示,入院血氯水平与全因死亡和心衰再入院复合终点风险负相关(HR=0.96,95%CI:0.94~0.99,P=0.012)。与T2组相比,T1组的全因死亡或心衰再住院风险显著增高(HR=1.29,95%CI:1.16~1.77,P<0.001);T3组与T2组之间比较,风险无统计学差异(HR=0.87,95%CI:0.69~1.08,P=0.219)。亚组分析未见交互作用。结论 急性失代偿心衰患者的入院血氯水平与短期全因死亡和心衰再住院复合风险独立负相关。

Objective To evaluate the impact of chlorine level at admission on the short-term prognosis of patients with acute decompensated heart failure(ADHF).Methods A retrospective analysis of Chinese adult hospitalized heart failure data published in PhysioNet was performed.Patients were divided into T1(CL≤100.2 mmol/L,n=604),T2(100.3<Cl≤104.8 mmol/L,n=606),and T3(CL>104.8 mmol/L,n=609)groups according to tertiles of blood chloride.The primary endpoint comprised 90-day all-cause death and rehospitalization for heart failure.Kaplan-Meier curves were used to assess the occurrence of endpoint events,and Cox regression models were constructed to analyze the risk predictors of endpoint events.Results Kaplan Meier's analysis showed that the composite risk of all-cause death and heart failure rehospitalization was significantly different among the three groups(P=0.010;There was a significant difference in the risk of rehospitalization for heart failure between groups(P=0.021),but not in the risk of all-cause mortality(P=0.470).Multivariate adjusted Cox model showed that admission serum chloride level was negatively associated with the risk of the composite endpoint of all-cause death and heart failure readmission(HR=0.96,95%CI:0.94~0.99,P=0.012).Compared with the T2 group,the T1 group had a significantly higher risk of all-cause death or heart failure rehospitalization(HR=1.29,95%CI:1.16~1.77,P<0.001;There was no significant difference in risk between the T3 and T2 groups(HR=0.87,95%CI:0.69-1.08,P=0.219).No interaction was seen for subgroup analyses.Conclusions Admission chloride in ADHF patients is negatively and independently associated with the compound risk of short-term all-cause death or heart failure rehospitalization.