Prevalence and Mortality of Hypochloremia Among Patients Suffering From Coronary Artery Disease and Congestive Heart Failure: An Analysis of Patients in CIN-I and MIMIC-III Databases

Abstract

Background: Hypochloremia is an independent predictor for mortality in patients with coronary artery disease (CAD) but whether the same correlation exists in CAD patients with congestive heart failure (CHF) is unclear.Methods: This is an analysis of data stored in the databases of the CIN-I [a registry of Cardiorenal Improvement (NCT04407936) in China from January 2007 to December 2018] and Medical Information Mart for Intensive Care (MIMIC)-III. CAD patients with CHF were included. The outcome measures were 90-day all-cause mortality (ACM) and long-term ACM.Results: Data from 8,243 CAD patients with CHF were analyzed. We found that 10.2% of the study population had hypochloremia (Cl− <98 mmol/L) in CIN-I (n = 4,762) and 20.1% had hypochloremia in MIMIC-III (n = 3,481). Patients suffering from hypochloremia were, in general, older and had a higher prevalence of comorbidities. After adjustment for confounders, hypochloremia remained a significant predictor of short-term mortality risk [90-day ACM: adjusted hazard ratio (aHR), 1.69; 95% CI, 1.27–2.25; P < 0.001 in CIN-I, and 1.36 (1.17–1.59); P < 0.001 in MIMIC-III]. Hypochloremia was also associated with long-term mortality [aHR, 1.26; 95% CI, 1.06–1.50; P = 0.009 in CIN-I, and 1.48 (1.32–1.66); P < 0.001 in MIMIC-III]. Prespecified subgroup analyses revealed an association of hypochloremia with long-term ACM to be attenuated slightly in the women of the two databases (P interaction < 0.05).Conclusions: Hypochloremia is independently associated with higher short-term and long-term ACM. Further studies are needed to determine if early preventive measurements and active intervention of hypochloremia can reduce the mortality risk of CAD patients with CHF.