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

Haozhang Huang; Jin Liu; Yan Liang; Kunming Bao; Linfang Qiao; Jiulin Liu; Qiang Li; Bo Wang; Shiqun Chen; Wenguang Lai; Cong Chen; Lingyu Zhang; Xiaoyu Huang; Dehua Huang; Jiyan Chen; Ning Tan; Yong Liu

doi:10.3389/fmed.2021.769646

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

Front Med (Lausanne). 2021 Dec 21:8:769646. doi: 10.3389/fmed.2021.769646. eCollection 2021.

Authors

Haozhang Huang^{1

2}, Jin Liu¹, Yan Liang³, Kunming Bao⁴, Linfang Qiao^{1

2}, Jiulin Liu^{1

2}, Qiang Li¹, Bo Wang¹, Shiqun Chen¹, Wenguang Lai^{1

5}, Cong Chen³, Lingyu Zhang³, Xiaoyu Huang⁶, Dehua Huang⁶, Jiyan Chen^{1

2

7}, Ning Tan^{1

2

7}, Yong Liu^{1

2

7}

Affiliations

¹ Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
³ Department of Cardiology, Maoming People's Hospital, Maoming, China.
⁴ Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.
⁵ Guangdong Provincial People's Hospital, School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China.
⁶ Department of Cardiology, People's Hospital of Yangjiang, Yangjiang, China.
⁷ Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.

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.

Keywords: congestive heart failure; coronary artery disease; hypochloremia; mortality; prevalence.