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 [DOI: 10.4254/wjh.v17.i3.103807]
Corresponding Author of This Article
Ramesh Kumar, MD, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, India. docrameshkr@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Mar 27, 2025; 17(3): 103807 Published online Mar 27, 2025. doi: 10.4254/wjh.v17.i3.103807
Hypochloremia is an underutilised prognostic marker in patients with advanced liver cirrhosis and liver failure
Jinit R Soni, Sudheer Marrapu, Ramesh Kumar
Jinit R Soni, Sudheer Marrapu, Ramesh Kumar, Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
Author contributions: Soni JR and Kumar R designed the concept, collected the data and wrote the manuscript research study; Marrapu S collected the data and wrote the manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramesh Kumar, MD, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, India. docrameshkr@gmail.com
Received: December 2, 2024 Revised: February 16, 2025 Accepted: February 27, 2025 Published online: March 27, 2025 Processing time: 115 Days and 14.7 Hours
Abstract
Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels. In such patients, hyponatremia has been identified as a predictor of poor outcomes. However, emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations. Hypochloremia, characterised by low serum chloride levels, has been linked to increased mortality, exacerbated organ dysfunction, and higher requirements for renal replacement therapy and vasopressors in various critical conditions, including advanced liver diseases. The pathophysiological mechanisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electrolyte imbalances, renal function, and systemic hemodynamics. Chloride dysregulation can influence renal salt-sensing mechanisms, disrupt acid-base homeostasis, and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome. This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease. By reviewing recent literature and analysing clinical data, we seek to establish serum chloride as an underutilised but valuable prognostic marker. Understanding the role of serum chloride in liver disease could enhance prognostic accuracy, refine treatment strategies, and ultimately improve patient outcomes.
Core Tip: Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels. Emerging evidence suggests that serum chloride may provide prognostic information in such patients. Hypochloremia has been associated with higher mortality, worsened liver dysfunction, and a greater need for vasopressors and renal replacement therapy. Despite its prognostic significance, serum chloride is often overshadowed by other electrolytes. Notwithstanding the limited available evidence, we believe that serum chloride is an underutilised prognostic marker in clinical practice. Thus, this article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.
