Association between fluctuations in serum chloride levels and 30-day mortality among critically ill patients: a retrospective analysis

BMC Anesthesiology

Hyo Jin Kim¹  Tak Kyu Oh²  In-Ae Song²  Jae Ho Lee³ 

[1] 0000 0004 0485 4871, grid.411635.4, Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik hospital, Seoul, South Korea;0000 0004 0647 3378, grid.412480.b, Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, 13620, Bundang-gu, Seongnam, Korea;0000 0004 0647 3378, grid.412480.b, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea;

关键词: Intensive care unit;    Mortality;    Sepsis;    Critical care;    Hyperchloremia;   

DOI  :  10.1186/s12871-019-0753-3

来源: publisher

【 摘 要 】

BackgroundThis study investigated the associations of fluctuations in serum chloride (Cl−) levels with 30-day mortality after intensive care unit (ICU) admission among critically ill patients.MethodsWe retrospectively analyzed the medical records of adult patients (≥18 years old) admitted to the ICU between January 2012 and December 2017. Positive and negative fluctuations in Cl− were defined as the differences between the Cl− upon ICU admission (baseline Cl−) and the maximum and minimum Cl− levels, respectively, measured within 72 h after ICU admission.ResultsThe final analysis included 18,825 adult patients. In multivariable Cox regression analyses, the risk of 30-day mortality increased by 8% per 1-mmol L− 1 positive fluctuation in Cl− within 72 h (hazard ratio = 1.08, 95% confidence interval: 1.04–1.11, P < 0.001). In subgroup analyses, a positive fluctuation in Cl− was associated with increased 30-day mortality among patients with a severe positive cumulative fluid balance (FB, > 10%), normochloremia (97–110 mmol L− 1) or hyperchloremia (> 110 mmol L− 1) upon ICU admission. Furthermore, a negative fluctuation in the Cl− level during the first 72 h of an ICU stay was associated with a negative cumulative FB (< 0%) or hypochloremia (< 97 mmol L− 1) upon ICU admission.ConclusionsA fluctuation in the Cl− level during the first 72 h of an ICU stay was found to associate independently with increased 30-day mortality among critically ill adult patients. However, the nature of this association differed according to the cumulative FB status or dyschloremia status upon ICU admission.

【 授权许可】

CC BY