title: Chloride Depletion Alkalosis as a Predictor of Inhospital Mortality in Patients with Decompensated Heart Failure.
abstract: OBJECTIVE
  Chloride depletion alkalosis (CDA) is often seen as a consequence of diuresis in heart failure (HF) but its prognostic significance remains unknown. The purpose of this study was to evaluate the prognostic role of CDA in decompensated HF (DHF).
  
  
  METHODS
  A retrospective cohort analysis was performed on 674 patients who were admitted with DHF. Patients were assigned to 2 groups based on the change in serum bicarbonate (median = 3 mmol/l) after diuresis, which was calculated by computing the difference in the admission and discharge serum bicarbonate: the CDA group (a change in serum bicarbonate ≥3 mmol/l) and the non-CDA group (change in serum bicarbonate <3 mmol/l). The primary end points were inhospital mortality and the composite end point of all-cause 30-day mortality and hospital readmission for HF.
  
  
  RESULTS
  In a multivariable logistic regression model, the CDA group, i.e. 374 patients, had a lower inhospital mortality than the non-CDA group, i.e. 300 patients (OR 0.11, 95% CI 0.03-0.38; p = 0.0005) after adjusting for other covariates. There was no statistically significant difference in the combined end point of all-cause 30-day mortality and readmission between the 2 groups (OR 1.26, 95% CI 0.74-2.12; p = 0.39).
  
  
  CONCLUSIONS
  The presence of CDA during hospitalization for DHF was independently associated with a better inhospital survival rate.
authors.affiliation: Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Mich., USA.
authors.forename: Nazia Naz S
authors.initials: NN
authors.lastname: Khan
authors.forename: Muhammad
authors.initials: M
authors.lastname: Nabeel
authors.forename: Bin
authors.initials: B
authors.lastname: Nan
authors.forename: Jalal K
authors.initials: JK
authors.lastname: Ghali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000471:Alkalosis / Q000097:blood*; D002712:Chlorides / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D010359:Patient Readmission; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D002712:Chlorides