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©The Author(s) 2025.
World J Hepatol. Mar 27, 2025; 17(3): 103807
Published online Mar 27, 2025. doi: 10.4254/wjh.v17.i3.103807
Published online Mar 27, 2025. doi: 10.4254/wjh.v17.i3.103807
Table 2 Studies demonstrating prognostic role of serum chloride in advanced liver disease patients, n (%)
Ref. | Study design | Patients (n) | Incidence of hypochloremia | Results | Limitations |
Sumarsono et al[14], 2020 | Retrospective cohort | 389 critically ill cirrhosis | 157 (40.4) | Hypochloremia was associated with higher in-hospital mortality (31% vs 19%, P < 0.01) as well as 180-day mortality (45.2% vs 26.7%, P < 0.0001) | Retrospective design, limited generalizability due to inclusion of only ICU cohort, one-time chloride measurement, and selection bias as indicated by lower overall ICU mortality rates |
Ji and Li[8], 2021 | Retrospective cohort | 1216 critically ill cirrhosis | 199 (16.4) | Hypochloremic patients had a significantly higher ICU mortality rate compared to non-hypochloremic ones (34.2% vs 15.8%, P < 0.001). Every unit decline in chloride level predicted 6% increase in mortality (OR 0.94) | Retrospective design, one-time chloride measurement, confounding variable not examined in multivariate model |
Cheng et al[39], 2023 | Retrospective cohort | 182 cirrhosis patients undergoing TIPS | Not stated | Patients with serum chloride < 107.35 mmol/L had significantly worse survival compared to those with levels ≥ 107.35 mmol/L. Each unit decline in chloride increased the mortality by 17.7% | Retrospective design, one-time chloride measurement during follow-up up to 1-year, and confounding effect of diuretics not assessed |
Wang et al[2], 2022 | Longitudinal cohort | 2405 ALF patients | 428 (17.8) | Hypochloremia group had lower 21-day transplant free survival (39% vs 50.2%, P < 0.001) and higher 28-day mortality (42.1%, P < 0.001) | Dynamic measurement of chloride not done, prior fluid and diuretic therapy might have affected serum chloride levels, and long-term prognosis not assessed |
Semmler et al[9], 2023 | Retrospective cohort | 891 ACLD; 181 critically ill cirrhosis | 138 (15) ACLD; 54 (30) critical cirrhosis | Serum chloride had a significant association with ICU mortality [OR: 0.94 (95%CI: 0.90-0.97)], even after adjusting for confounders [adjusted OR: 3.20 (95%CI: 1.20-8.82)]. Those with chloride < 100 mmol/L exhibited significantly higher odds of ICU mortality than otherwise | Retrospective design, Vomiting or diarrhea or treatment (diuretics, fluids or lactulose) prior to as well as first few hours of admission might have impacted serum electrolytes |
- Citation: Soni JR, Marrapu S, Kumar R. Hypochloremia is an underutilised prognostic marker in patients with advanced liver cirrhosis and liver failure. World J Hepatol 2025; 17(3): 103807
- URL: https://www.wjgnet.com/1948-5182/full/v17/i3/103807.htm
- DOI: https://dx.doi.org/10.4254/wjh.v17.i3.103807