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Published on: June 11, 2012
Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients
Javier A Neyra1, Fabrizio Canepa-Escaro, Xilong Li
11Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX. 2Department of Internal Medicine, Asante Health System, Grants Pass, OR. 3Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX. 4Division of Nephrology, Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 5Division of Nephrology and Hypertension, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI. 6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.
Insights
In septic ICU patients with hyperchloremia, higher serum chloride levels at 72 hours and worsening chloride levels during ICU stay were linked to increased hospital mortality. This finding highlights the prognostic significance of chloride dynamics in critical illness.
Area of Science:
- Critical Care Medicine
- Nephrology
- Internal Medicine
Background:
- Hyperchloremia is a common electrolyte disturbance in critically ill patients.
- Understanding its impact on mortality in sepsis is crucial for patient management.
Purpose of the Study:
- To investigate the association between serum chloride levels and hospital mortality in patients with severe sepsis or septic shock.
- To determine if initial or dynamic changes in chloride levels predict outcomes.
Main Methods:
- Retrospective cohort study of 1,940 adult ICU patients with severe sepsis or septic shock.
- Serum chloride levels were measured on ICU admission (Cl0) and at 72 hours (Cl72).
- Multivariate analysis assessed the association of Cl0, Cl72, and delta Cl (ΔCl) with all-cause hospital mortality.
Main Results:
- 31.7% of patients presented with hyperchloremia (Cl ≥ 110 mEq/L) on admission.
- Higher Cl72 levels were independently associated with increased hospital mortality (aOR 1.27 per 5 mEq/L increase).
- Worsening hyperchloremia (ΔCl) was also independently associated with mortality (aOR 1.37 per 5 mEq/L increase).
Conclusions:
- In septic ICU patients with initial hyperchloremia, elevated chloride levels at 72 hours and worsening chloride levels during the ICU stay are independently associated with hospital mortality.
- These associations persist even after adjusting for factors like base deficit, fluid balance, and acute kidney injury.
- Dynamic monitoring of serum chloride may offer prognostic value in critically ill septic patients.
Objectives:
Hyperchloremia is frequently observed in critically ill patients in the ICU. Our study aimed to examine the association of serum chloride (Cl) levels with hospital mortality in septic ICU patients.
Design:
Retrospective cohort study.
Setting:
Urban academic medical center ICU.
Patients:
ICU adult patients with severe sepsis or septic shock who had Cl measured on ICU admission were included. Those with baseline estimated glomerular filtration rate less than 15 mL/min/1.73 m or chronic dialysis were excluded.
Interventions:
None.
Measurements And Main Results:
Of 1,940 patients included in the study, 615 patients (31.7%) had hyperchloremia (Cl ≥ 110 mEq/L) on ICU admission. All-cause hospital mortality was the dependent variable. Cl on ICU admission (Cl0), Cl at 72 hours (Cl72), and delta Cl (ΔCl = Cl72 - Cl0) were the independent variables. Those with Cl0 greater than or equal to 110 mEq/L were older and had higher cumulative fluid balance, base deficit, and Sequential Organ Failure Assessment scores. Multivariate analysis showed that higher Cl72 but not Cl0 was independently associated with hospital mortality in the subgroup of patients with hyperchloremia on ICU admission (adjusted odds ratio for Cl72 per 5 mEq/L increase = 1.27; 95% CI, 1.02-1.59; p = 0.03). For those who were hyperchloremic on ICU admission, every within-subject 5 mEq/L increment in Cl72 was independently associated with hospital mortality (adjusted odds ratio for ΔCl 5 mEq/L = 1.37; 95% CI, 1.11-1.69; p = 0.003).
Conclusions:
In critically ill septic patients manifesting hyperchloremia (Cl ≥ 110 mEq/L) on ICU admission, higher Cl levels and within-subject worsening hyperchloremia at 72 hours of ICU stay were associated with all-cause hospital mortality. These associations were independent of base deficit, cumulative fluid balance, acute kidney injury, and other critical illness parameters.
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