Hypochloremia in Adult Patients with Cirrhosis

Background: Liver cirrhosis is a leading global health burden. Cirrhosis-related mortality is increasing, and clinical outcomes are often worsened by electrolyte imbalances. While serum sodium is well-established as a prognostic marker in cirrhosis, less is known about the role of serum chloride. Evidence from studies in heart failure and chronic kidney disease has shown that hypochloremia is associated with increased mortality. This study aims to evaluate the association between serum chloride levels at hospital admission and clinical outcomes in adult patients with cirrhosis. Methods: We will conduct a retrospective cohort study of adults with cirrhosis admitted to Mayo Clinic (Rochester, MN) between 2010 and 2024. Clinical, demographic, and laboratory data will be extracted from electronic medical records. Chloride levels will be categorized into four groups: <94, 94–99, 100–108 (reference), and >108 mmol/L. Outcomes included analysis of baseline characteristics, laboratory parameters, and in-hospital/ 1 year mortality across the 4 groups. Results: The study included 582 patients with mean age of 57.2 years and 61.3% male patients. The median value of serum chloride level was 104.7 mmol/L (101–108 mmol/L). Patients in the lowest serum chloride group had lower sodium levels, higher creatinine, BUN, bilirubin, potassium and magnessium levels, higher platelet count and lower urine osmolarity(p<0.05). No significant difference was found between the four groups of chloride levels in terms of age, sex, baseline characteristics, any comorbidities, and the prevalence of loop diuretic use.In-hospital mortality was 5.67%, with a median hospital length of stay of 7 days (IQR, 4-12 d) and median ICU length of stay of 2 days (IQR, 1–3 d). Patients were followed for 1 year from their ICU admission date for all-cause mortality, 133 patients (22.9%) were deceased. There were 51 (23.6%), 37(18.9%), 27 (23.7%) and 18 (32.1%) deaths for the >108, 100–108, 94–99 and <94mmol/L groups, respectively. Conclusion: Our findings suggest that hypochloremia in patients with cirrhosis is associated with adverse laboratory profiles and higher one-year mortality. While this highlights the potential prognostic value of serum chloride, further prospective studies with larger and more diverse patient populations are needed to confirm these associations and explore underlying mechanisms.