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Increase in chloride from baseline is independently associated with mortality in critically ill children
Matthew F Barhight1, John Brinton2, Timothy Stidham3
1Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA. mbarhight@luriechildrens.org.
Insights
An increase in serum chloride levels in critically ill children is common and a significant risk factor for mortality. Monitoring chloride changes may improve outcomes for these vulnerable patients.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Chemistry
- Electrolyte Balance
Background:
- Electrolyte disturbances are common in critically ill children.
- Chloride levels play a crucial role in maintaining acid-base balance and fluid homeostasis.
- Understanding the impact of chloride variations on mortality is essential for improving patient care.
Purpose of the Study:
- To investigate the association between admission chloride levels and in-hospital mortality in critically ill children.
- To determine if an increase in serum chloride within the first day of admission is linked to mortality.
- To identify chloride level changes as potential risk factors for adverse outcomes in pediatric intensive care.
Main Methods:
- Retrospective cohort study of patients admitted to the pediatric intensive care unit (PICU) between 2014 and 2015.
- Exclusion criteria included specific age ranges, cardiac ICU admissions, lack of laboratory values, end-stage renal disease, chloride transport disorders, and diabetic ketoacidosis.
- Patients were stratified by admission chloride levels (hypochloraemia, normochloraemia, hyperchloraemia) and by chloride increase on day 1 (≥5 mEq/L vs. <5 mEq/L).
Main Results:
- A total of 1935 critically ill children were analyzed, with an overall mortality rate of 4%.
- Hyperchloraemia was observed in 21% of patients, and a chloride increase of ≥5 mEq/L on day 1 occurred in 12%.
- After adjusting for confounders, a chloride increase of ≥5 mEq/L was independently associated with a 2.3-fold increased odds of mortality (95% CI 1.03-5.21).
Conclusions:
- An increase in serum chloride level within the first day of PICU admission is a frequent occurrence.
- This chloride level increase serves as an independent risk factor for mortality in critically ill children.
- Further research is needed to elucidate the mechanisms by which chloride disturbances impact mortality risk in this population.
Purpose:
To determine if there is an association between mortality and admission chloride levels and/or increases in the chloride level in critically ill children.
Methods:
We performed a retrospective cohort study of all patients admitted to the paediatric intensive care unit (PICU) from January 2014 to December 2015. Patients were excluded for the following reasons: (1) age < 90 days or > 18 years, (2) admission to the cardiac intensive care unit, (3) no laboratory values upon admission to the PICU, (4) history of end-stage renal disease, (5) a disorder of chloride transport, and (6) admission for diabetic ketoacidosis. The patients were stratified on the basis of admission chloride levels (hypochloraemia, < 96 mEq/L; normochloraemia, 96-109 mEq/L; and hyperchloraemia, ≥ 110 mEq/L) and dichotomised on the basis of an increase in chloride in the first day (< 5 mEq/L, ≥ 5 mEq/L). Our primary outcome was in-hospital mortality.
Results:
A total of 1935 patients [55% female, median age 6.3 years IQR (1.9-13.4)] were included. The overall mortality was 4% (n = 71) and day 2 AKI occurred in 17% (n = 333. Hypochloraemia, hyperchloraemia, and an increase in serum chloride ≥ 5 mEq/L occurred in 2%, 21%, and 12%, respectively. After adjusting for confounders, increase in chloride ≥ 5 mEq/L was associated with a 2.3 (95% CI 1.03-5.21) greater odds of mortality.
Conclusions:
An increase in serum chloride level in the first day of admission is common and an independent risk factor for mortality in critically ill children. Further studies are warranted to identify how chloride disturbances contribute to mortality risk in critically ill children.
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