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Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients

Thomas J Breen1, Benjamin Brueske2, Mandeep S Sidhu2

  • 1Department of Internal Medicine, Mayo Clinic, Rochester MN, United States of America.

Plos One
|April 26, 2021
PubMed

Insights

Abnormal serum chloride levels in cardiac intensive care unit (CICU) patients are linked to higher mortality rates. Hypochloremia, in particular, is a significant predictor of both short-term and long-term death.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Clinical Chemistry

Background:

  • Serum chloride levels are crucial electrolytes affecting physiological functions.
  • Electrolyte disturbances, including dyschloremia, are common in critically ill patients.
  • The prognostic value of serum chloride in cardiac intensive care unit (CICU) populations requires further elucidation.

Purpose of the Study:

  • To investigate the association between admission serum chloride levels and both hospital and post-discharge mortality in unselected CICU patients.
  • To determine if dyschloremia (hypochloremia or hyperchloremia) independently predicts mortality in this cohort.

Main Methods:

  • Retrospective review of 9,426 adult CICU patients admitted between 2007 and 2015.
  • Assessment of the association between dyschloremia and hospital mortality using multivariable models.
  • Evaluation of the association between dyschloremia and post-discharge mortality using Cox proportional-hazards analysis.

Main Results:

  • 15% of patients presented with hypochloremia and 17% with hyperchloremia.
  • Both hypochloremia and hyperchloremia were associated with increased unadjusted hospital mortality.
  • After multivariate adjustment, hypochloremia remained a significant predictor of higher hospital mortality (aOR 2.1) and increased post-discharge mortality (aHR 1.3).

Conclusions:

  • Abnormal serum chloride levels on CICU admission are associated with increased short-term and long-term mortality.
  • Hypochloremia is identified as a strong, independent predictor of mortality in CICU patients.
  • These findings highlight the importance of monitoring serum chloride levels for risk stratification in critical cardiac care.
Abstract

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