Kadar klorida serum admisi dan perubahan klorida serum dalam 72 jam sebagai prediktor respon diuresis, rehospitalisasi dan kematian pada pasien gagal jantung akut
Authors: Pertiwi Gusti Ayu Riska , Wiryawan I Nyoman , Darma I Kadek Susila Surya , Yasmin Anak Agung Ayu Dwi Adelia , Suastika Luh Oliva Saraswati , Putra I Wayan Gede Artawan Eka 
Published: September 2024

Introduction: Acute changes in chloride level occur due to an increase in urinary chloride excretion after furosemide administration and are considered to have a different prognostic role compared to admission chloride level. This study aimed to determine the role of admission chloride serum and 72-hour changes in chloride serum as predictors of diuretic response, and rehospitalization due to worsening heart failure and cardiovascular death in acute heart failure (AHF) patients.
Methods: This was a prospective cohort study enrolling AHF patients aged ≥18 years who received intravenous (IV) furosemide therapy. Admission chloride was obtained within 24 hours after the patient was admitted. Meanwhile, changes in 72-hour chloride were calculated based on the difference between 72-hour chloride and admission levels.
Result: From a total of 76 subjects with AHF, the rehospitalization and the composite of rehospitalization and/or death were found in 25% and 26.3% of subjects. Both admission hypochloremia and no-decrease in 72-hour chloride level were independently associated with less diuretic response (value <median) (adjusted-Odd Ratio (OR) 5.71; 95% Confidence Interval (CI) 1.47 – 22.10; p=0.012 and adjusted-OR 3.08; 95% CI 1.03 – 9.24)). Admission hypochloremia was an independent predictor of the 30-day rehospitalization and composite rehospitalization and/or death (adjusted-Hazard Ratio (HR) 5.91; 95% CI 2.22 – 15.77; p<0.001 and adjusted-HR 4.24; 95% CI 1.60 – 11.26; p=0.004, respectively).
Conclusion: Admission chloride dan change in 72-hour chloride level associated with diuretic response, rehospitalization and mortality in AHF. Admission hypochloremia had better predictive power to evaluate risk for adverse outcome in AHF.

Latar belakang: Perubahan akut klorida selama rawat inap terjadi akibat meningkatnya ekskresi klorida melalui urin pasca pemberian furosemid dan diperkirakan memiliki hubungan prognostik berbeda dibandingkan kadar klorida admisi. Penelitian bertujuan mengetahui peran klorida serum admisi dan perubahan klorida 72 jam sebagai prediktor respon diuresis, rehospitalisasi akibat perburukan gagal jantung dan kematian kardiovaskular pada pasien GJA.
Metode: Ini adalah penelitian kohort prospektif pada pasien gagal jantung akut (GJA) berusia ≥18 tahun dan mendapat terapi furosemid intravena (iv). Kadar klorida admisi diambil dari pemeriksaan klorida serum dalam 24 jam sejak pasien dirawat. Sedangkan perubahan klorida 72 jam dinilai berdasarkan selisih antara klorida 72 jam dan admisi.
Hasil: Dari 76 subjek dengan GJA, kejadian rehospitalisasi dan komposit rehospitalisasi dan/atau kematian ditemukan pada 25% dan 26,3% subyek. Hipokloremia admisi dan tidak terjadi penurunan klorida 72 jam secara independen berhubungan dengan respon diuresis kurang (nilai<median) (adjusted Odd Ratio (OR) masing – masing 5,71; Interval Kepercayaan (IK) 95% 1,47 – 22,10; p=0,012 dan adjusted OR 3,08; IK 95% 1,03 – 9,24; p= 0,044)). Hipokloremia admisi terbukti sebagai prediktor independen rehospitalisasi dan komposit rehospitalisasi dan/atau kematian dalam 30 hari (adjusted Hazard Ratio (HR) 5,91; IK 95% 2,22 – 15,77; p<0,001 dan adjusted HR 4,24; IK 95% 1,60 – 11,26; p=0,004).
Simpulan:Klorida admisi dan perubahan klorida 72 jam berhubungan dengan respon diuresis, dan luaran rehospitalisasi dan kematian pada pasien GJA. Dibandingkan perubahan klorida, hipokloremia saat admisi memiliki kemampuan prediktif yang lebih baik dalam menilai risiko luaran buruk jangka pendek pada GJA.