Hyperchloremia Is Associated With Complicated Course and Mortality in Pediatric Patients With Septic Shock

Area of Science:

• Pediatric critical care medicine
• Nephrology
• Intensive care research

Background:

• Hyperchloremia is associated with adverse outcomes in critically ill adults.
• The relationship between hyperchloremia and outcomes in critically ill children with septic shock remains unclear.

Purpose of the Study:

• To determine if hyperchloremia is associated with poor outcomes in children experiencing septic shock.
• To investigate the independent association between elevated serum chloride and adverse events in pediatric septic shock.

Main Methods:

• Retrospective analysis of a pediatric septic shock database from 29 US PICUs.
• Inclusion of 890 children aged 10 years and younger with septic shock.
• Evaluation of minimum, maximum, and mean chloride values (≥110 mmol/L) within the first 7 days using multivariable logistic regression, adjusting for illness severity.

Main Results:

• A minimum serum chloride level ≥110 mmol/L was associated with increased odds of a complicated course (OR, 1.9) and mortality (OR, 3.7).
• A mean serum chloride level ≥110 mmol/L was also associated with increased odds of mortality (OR, 2.1).
• Secondary analyses using biomarker-based risk stratification yielded similar findings.

Conclusions:

• Hyperchloremia is an independent predictor of poor outcomes in children with septic shock.
• Elevated chloride levels are significantly associated with increased mortality and complicated courses in this pediatric population.
• Monitoring and potentially managing chloride levels may be crucial for improving outcomes in pediatric septic shock.