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Association between serum chloride and in-hospital mortality in congestive heart failure with diabetes: Data from the
Kai Zhang1, Yu Han2, Fangming Gu3
1Cardiovascular Surgery Department of the Second Hospital of Jilin University, No. 218, Ziqiang Street, Changchun, Jilin Province China.
Insights
Higher serum chloride levels were linked to lower in-hospital mortality in patients with congestive heart failure and diabetes. This finding suggests chloride may be a significant factor in critical care outcomes for these patients.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Nephrology
Background:
- Congestive heart failure (CHF) and diabetes mellitus frequently coexist in intensive care unit (ICU) patients.
- Abnormal serum chloride levels are common in critical illness but their prognostic value is unclear.
- This study investigates the association between serum chloride and mortality in ICU patients with both CHF and diabetes.
Purpose of the Study:
- To examine the relationship between serum chloride levels on ICU admission and in-hospital mortality.
- To determine the clinical significance of serum chloride in critically ill patients with comorbid CHF and diabetes.
Main Methods:
- Retrospective cohort study using the MIMIC-IV database.
- Inclusion of adult patients in the United States with coexisting CHF and diabetes.
- Analysis of serum chloride levels and in-hospital mortality using multivariable logistic regression, generalized additive models, and subgroup analysis.
Main Results:
- The study included 7,063 patients.
- An inverse association was found between serum chloride levels and in-hospital mortality.
- Higher chloride levels (Q3 vs Q1) showed an odds ratio (OR) of 0.73 (95% CI: 0.54-0.98, p=0.039); a 1 mmol/L increase had an OR of 0.97 (95% CI: 0.96-0.99, p=0.01).
Conclusions:
- Serum chloride levels are negatively associated with in-hospital mortality in patients with CHF and diabetes.
- The observed relationship was linear and robust across subgroup analyses.
- Further prospective, randomized controlled studies are needed to confirm these findings.
Background:
Congestive heart failure (CHF) demonstrates a heightened prevalence in individuals with diabetes mellitus within Intensive Care Units. The occurrence of abnormal chloride levels is frequently observed in critically ill patients, yet its clinical significance remains subject to debate. This study endeavors to explore the relationship between serum chloride levels and in-hospital mortality among patients affected by both congestive heart failure and diabetes.
Methods:
A retrospective cohort study was conducted, utilizing data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database, focusing on adult patients in the United States. The impact of serum chloride levels upon ICU admission on in-hospital mortality was analyzed using multivariable logistic regression models, generalized additive models and subgroup analysis.
Results:
The study encompassed 7,063 patients with coexisting diabetes and congestive heart failure. The fully adjusted model revealed an inverse association between serum chloride levels and in-hospital mortality. As a tertile variable (Q3 vs Q1), the odds ratio (OR) was 0.73 with a 95% confidence interval (CI) of 0.54-0.98 (p = 0.039). As a continuous variable, per 1 mmol/L increment, the OR (95% CI) was 0.97 (0.96-0.99, p = 0.01). The relationship between serum chloride and in-hospital mortality demonstrated linearity (non-linear p = 0.958). Stratified analyses further validated the robustness of this correlation.
Conclusions:
Serum chloride levels exhibited a negative association with in-hospital mortality in patients with both congestive heart failure and diabetes. Nevertheless, prospective, randomized, controlled studies are warranted to corroborate and validate the findings presented in this investigation.
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