# Hypochloremia, non-medication related associated factors, and impact on clinical outcomes in patients with acute heart failure: Insights from resource limited setups

## TL;DR

This study finds that low chloride levels in hospitalized heart failure patients are common and linked to worse outcomes like longer hospital stays and higher mortality.

## Contribution

The study identifies non-medication factors associated with hypochloremia in acute heart failure patients in low-resource settings.

## Key findings

- Hypochloremia was present in 33.1% of acute heart failure patients.
- Hypochloremic patients had longer hospital stays and higher in-hospital mortality.
- Severe heart failure, COPD, hypokalemia, and hyponatremia were independently associated with hypochloremia.

## Abstract

Electrolyte disturbances such as hypochloremia are common in patients with acute heart failure (AHF) and may worsen clinical outcomes. However, data from low-resource settings remain limited. Therefore, the aim of this study is to determine the prevalence of hypochloremia among AHF patients, assess its association with length of hospital stay and in-hospital mortality, and identify factors independently associated with its occurrence.

To determine the prevalence of hypochloremia among patients admitted with acute heart failure, to assess its non-medication association with length of hospital stay and in-hospital mortality, and to identify factors independently associated with hypochloremia in a resource-limited setting.

A retrospective observational cohort study of hospitalized patients with acute heart failure, with serum chloride measured at admission was conducted among 260 patients aged ≥16. Data were analysed using SPSS version 26.0. The association between hypochloremia and clinical outcomes, including in-hospital mortality and length of hospital stay, was assessed using the Chi-square test and the Mann–Whitney U test, respectively. Multivariable logistic regression analysis was performed to identify independent predictors of hypochloremia. A p-value of <0.05 was considered statistically significant.

The prevalence of hypochloremia was 33.1% (95% CI: 27.4%–39.2%), and hypochloremic patients had significantly longer hospital stays (median: 12 days vs. 8.5 days; p = 0.001) and higher in-hospital mortality (χ² = 8.58; p = 0.003). Multivariate analysis showed that NYHA class IV heart failure [AOR = 6.96; 95% CI: 1.49–32.4; p = 0.014], history of COPD [AOR = 4.94; 95% CI: 1.36–17.9; p = 0.001], hyponatremia [AOR = 2.20; 95% CI: 1.8–9.5; p = 0.001], and hypokalemia [AOR = 4.08; 95% CI: 1.53–10.6; p = 0.004] were significantly associated with hypochloremia.

In this study hypochloremia at admission was common and associated with higher in-hospital mortality and longer hospital stays. It was more frequently observed in patients with severe heart failure, COPD, hypokalemia and hyponatremia.