低氯血症对肝硬化2或3级腹水患者短期预后的影响
Effect of hypochloremia on short-term prognosis in patients with cirrhosis and grade 2 or 3 ascites
摘要
Abstract
Objective To explore the impact of hypochloremia on the short-term adverse prognosis in patients with liver cirrhosis and grade 2 or 3 ascites.Methods A total of 119 hospitalized patients diagnosed with liver cirrhosis complicated with grade 2 or 3 ascites were retrospectively enrolled from October 1,2022 to September 30,2023.The X-tile software was used to determine the optimal cut-off value of serum Cl-.The primary adverse clinical outcomes included 1-year all-cause mortality,progressive decompensation,and/or readmission due to recurrent ascites.Cox regression analysis,Kaplan-Meier survival curves,and time-dependent receiver operating characteristic(ROC)curves were applied to evaluate the predictive value of serum Cl-.Subgroup analyses were further performed based on the presence or absence of primary hepatic carcinoma(PHC).Results The optimal cut-off value of serum Cl-for predicting 1-year adverse clinical outcomes in these patients was determined as 104.9 mmol/L via X-tile analysis.Multivariate Cox regression analysis showed that serum Cl-<104.9 mmol/L was an independent risk factor for 1-year mortality(HR=2.351,95%CI 1.390-3.977),progressive decompensation(HR=3.267,95%CI 1.682-6.344),and ascites-related readmission(HR=2.009,95%CI 1.013-3.991)(P<0.05).Kaplan-Meier curves revealed that the cumulative risks of the above adverse events were significantly higher in patients with serum Cl-<104.9 mmol/L than in those with serum Cl-≥104.9 mmol/L(Log-rank P<0.05).Time-dependent ROC curves and Delong tests indicated that the predictive efficacy of serum Cl-was comparable to that of the traditional Child-Pugh score and Model for End-Stage Liver Disease(MELD)score(P>0.05).Subgroup analyses demonstrated that serum Cl-<104.9 mmol/L had a favorable predictive value for mortality in both subgroups with or without PHC.However,its predictive effect on progressive decompensation was only significant in patients without PHC,and no obvious predictive difference was observed in ascites-related readmission between the two subgroups.Conclusion Lower serum Cl-level(<104.9 mmol/L)is an independent risk factor for short-term adverse prognosis in patients with liver cirrhosis and grade 2 or 3 ascites,and correction of hypochloremia may serve as a crucial strategy to improve clinical outcomes of such patients.关键词
低氯血症/肝硬化/腹水/不良预后Key words
hypochloremia/liver cirrhosis/ascites/adverse prognosis分类
医药卫生引用本文复制引用
王晴晴,丁洁,李海雯,刘怀鄂,耿鹏,李生浩,杨永锐..低氯血症对肝硬化2或3级腹水患者短期预后的影响[J].解放军医学杂志,2026,51(8):1195-1205,11.基金项目
This work was supported by the National Natural Science Foundation of China(82260408),the Science Research Fund of Education Department of Yunnan Province(2024J0863),the Specialized Union Program between Science and Technology Department and Local Universities of Yunnan Province(202501BA070001-057),the High-Level Health and Medical Technical Talent of Yunnan Province(D-2025037),the Social Development and Science and Technology Benefiting Public Program of Kunming STB(2025-NS-029),the 535 Talent Project of First Affiliated Hospital of Kunming Medical University(2023535D14),and the Health Research Project of Kunming Municipal Health Commission(2025-02-04-001,2025-03-03-005,2025-03-08-020) 国家自然科学基金(82260408) （82260408）
云南省教育厅科学研究基金项目(2024J0863) （2024J0863）
云南省科技厅-地方高校联合专项(202501BA070001-057) （202501BA070001-057）
云南省高层次卫生健康技术人才培养专项(D-2025037) （D-2025037）
昆明市科技局社会发展与科技惠民计划项目(2025-NS-029) （2025-NS-029）
昆明医科大学第一附属医院"535人才工程"(2023535D14) （2023535D14）
昆明市卫健委卫生科研项目(2025-02-04-001,2025-03-03-005,2025-03-08-020) （2025-02-04-001,2025-03-03-005,2025-03-08-020）
