Impact of Moderate Hyperchloremia on Clinical Outcomes in Intracerebral Hemorrhage Patients Treated With Continuous Infusion Hypertonic Saline: A Pilot Study

Riha, Heidi; Erdman, Michael; Vandigo, Joseph; Kimmons, Lauren A.; Goyal, Nitin; Davidson, K. Erin; Pandhi, Abhi; Jones, G. Morgan

doi:10.1097/ccm.0000000000002522

Cited by 54 publications

(41 citation statements)

References 31 publications

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“…Similar to these studies, we observed that both new-onset hyperchloremia or every 5 mmol/L increment in Δ[Cl − ] were associated with increased odds of poor outcome in critically ill stroke patients, although these two variables did not show independent significance in multivariate models. The possible explanation could be that the prevalence of hyperchloremia in our subjects (17.0% in the first 72 h) was much lower than that in other patient groups [65.3% ( 13 ) in patients with ICH and treated with hypertonic saline; 40.8% (( 10 )) and 31.7% ( 9 ) in patients with septic shock].…”

Section: Discussioncontrasting

confidence: 55%

“…Hyperchloremia has been reported to be associated with increased hospital mortality and negative outcome in critically ill patients ( 8 ), with severe sepsis and septic shock ( 9 , 10 ), as well as after surgery and trauma ( 11 , 12 ). In patients with ICH, a recent study demonstrated higher rates of in-hospital mortality in those who developed moderate hyperchloremia during treatment with continuous intravenous infusion of 3% hypertonic saline, with moderate hyperchloremia independently predicting in-hospital mortality ( 13 ). Another study in patients with subarachnoid hemorrhage found a strong association between hyperchloremia and acute kidney injury (AKI) as well as AKI and mortality ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Hyperchloremia Is Associated With Poorer Outcome in Critically Ill Stroke Patients

Huang

et al. 2018

Front. Neurol.

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Background and Purpose: This study aims to explore the cause and predictive value of hyperchloremia in critically ill stroke patients.Materials and Methods: We conducted a retrospective study of a prospectively collected database of adult patients with first-ever acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) admitted to the neurointensive care unit (NICU) of a university-affiliated hospital, between January 2013 and December 2016. Patients were excluded if admitted beyond 72 h from onset, if they required neurocritical care for less than 72 h, and were treated with hypertonic saline within 72 h or had creatinine clearance less than 15 mL/min.Results: Of 405 eligible patients, the prevalence of hyperchloremia ([Cl−] ≥ 110 mmol/L) was 8.6% at NICU admission ([Cl−]0) and 17.0% within 72 h ([Cl−]max). Thirty-eight (9.4%) patients had new-onset hyperchloremia and 110 (27.1%) had moderate increase in chloride (Δ[Cl−] ≥ 5 mmol/L; Δ[Cl−] = [Cl−]max − [Cl−]0) in the first 72 h after admission, which were found to be determined by the sequential organ failure assessment score in multivariate logistic regression analysis. Neither total fluid input nor cumulative fluid balance had significant association with such chloride disturbance. New-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl−] were both associated with increased odds of 30-day mortality and 6-month poor outcome, although no independent significance was found in multivariate models.Conclusion: Hyperchloremia tends to occur in patients more severely affected by AIS and ICH. Although no independent association was found, new-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl−] were related to poorer outcome in critically ill AIS and ICH patients.Subject terms: clinical studies, intracranial hemorrhage, ischemic stroke, mortality/survival, quality and outcomes.

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Section: Discussioncontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Hyperchloremia Is Associated With Poorer Outcome in Critically Ill Stroke Patients

Huang

et al. 2018

Front. Neurol.

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“…Similar to recent evidence in patients with other underlying neurological pathologies, hyperchloremia may have an impact on overall clinical outcomes in this patient population. 11 -13…”

Section: Discussionmentioning

confidence: 99%

“…11 A multicenter study of patients with intracerebral hemorrhage (ICH) identified moderate hyperchloremia (≥115 mmol/L) as an independent predictor of inhospital mortality. 12 Finally, a study evaluating a mixed cohort of patients with hemorrhagic and ischemic stroke found that hyperchloremia (>110 mmol/L) development within 72 hours of admission was also associated with increased mortality. 13 To date, no study has examined the effects of hyperchloremia solely in acute ischemic stroke (AIS), although it accounts for nearly 87% of strokes in the United States.…”

Section: Introductionmentioning

confidence: 99%

An Association Between Hyperchloremia and Acute Kidney Injury in Patients With Acute Ischemic Stroke

Haller

Smetana

Erdman

et al. 2020

The Neurohospitalist

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Background and Purpose: While an association between hyperchloremia and worse outcomes, such as acute kidney injury and increased mortality, has been demonstrated in hemorrhagic stroke, it is unclear whether the same relationship exists after acute ischemic stroke. This study aims to determine the relationship between moderate hyperchloremia (serum chloride ≥115 mmol/L) and acute kidney injury in patients with ischemic stroke. Methods: This is a multicenter, retrospective, propensity-matched cohort study of adults admitted for acute ischemic stroke. The primary objective was to determine the relationship between moderate hyperchloremia and acute kidney injury, as defined by the Acute Kidney Injury Network criteria. Secondary objectives included mortality and hospital length of stay. Results: A total of 407 patients were included in the unmatched cohort (332 nonhyperchloremia and 75 hyperchloremia) and 114 patients (57 in each group) were matched based upon propensity scores. In the matched cohort, hyperchloremia was associated with an increased risk of acute kidney injury (relative risk 1.91 [95% confidence interval 1.01-3.59]) and a longer hospital length of stay (16 vs 12 days; P = .03). Mortality was higher in the hyperchloremia group (19.3% vs 10.5%, P = .19), but this did not reach statistical significance. Conclusions: In this study, hyperchloremia after ischemic stroke was associated with increased rates of acute kidney injury and longer hospital length of stay. Further research is needed to determine which interventions may increase chloride levels in patients with acute ischemic stroke and the association between hyperchloremia and clinical outcomes.

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“…On the other hand, we included patients with preoperative CKD and adjusted for CKD in the multivariable logistic analysis. In addition, several studies that reported an association between hyperchloremia and AKI in patients with major trauma [ 20 ], subarachnoid hemorrhage [ 8 ], severe sepsis or septic shock [ 7 ], or intracerebral hemorrhage [ 21 ] included patients who received large volumes of NaCl 0.9%. Our study differs from those previous investigations in that we included patients who were admitted to the ICU after undergoing any type of surgery.…”

Section: Discussionmentioning

confidence: 99%

Hyperchloremia and postoperative acute kidney injury: a retrospective analysis of data from the surgical intensive care unit

Song

Kim

et al. 2018

Crit Care

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BackgroundWhether perioperative hyperchloremia can induce postoperative acute kidney injury (AKI) is controversial. We investigated the association between perioperative hyperchloremia and postoperative AKI in patients admitted to the intensive care unit (ICU) after surgery.MethodsWe performed a retrospective observational study of patients admitted to the surgical ICU at a single tertiary care hospital between January 2011 and June 2016. Our primary objective was to determine whether hyperchloremia or an increase in serum chloride levels was associated with postoperative AKI. Perioperative hyperchloremia was defined as serum chloride levels ≥ 110 mmol·L− 1 during postoperative days (PODs) 0–3. The increase in serum chloride levels was defined as the difference between preoperative and maximum postoperative serum chloride levels during the first 3 days after surgery.ResultsOf the 7991 patients included in the final analysis, 1876 (23.5%) developed hyperchloremia during PODs 0–3, and 1187 (14.9%) developed postoperative AKI. Exposure to hyperchloremia during the first 3 days after surgery was not associated with postoperative AKI (odds ratio, 1.09; 95% confidence interval, 0.80–1.49; P = 0.571). However, among patients with preoperative chronic kidney disease stage ≥ 3 (estimated glomerular filtration rate < 60 mL·min− 1·1.73·m− 2), the incidence of postoperative AKI was higher in patients with an increase > 6 mmol·L− 1 in serum chloride levels than in patients with an increase ≤ 1 mmol·L− 1 (odds ratio, 1.42; 95% confidence interval, 1.09–1.84; P = 0.009). In addition, the incidence of postoperative AKI stage ≥ 2 was not associated with exposure to hyperchloremia or with the increase in serum chloride levels during PODs 0–3, regardless of preoperative kidney function.ConclusionsExposure to perioperative hyperchloremia is not associated with postoperative AKI in surgical ICU patients. However, in patients with moderate-to-severe chronic kidney disease (stage ≥ 3), a substantial perioperative increase in serum chloride levels may reflect a higher risk of AKI.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2216-5) contains supplementary material, which is available to authorized users.

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Impact of Moderate Hyperchloremia on Clinical Outcomes in Intracerebral Hemorrhage Patients Treated With Continuous Infusion Hypertonic Saline: A Pilot Study

Cited by 54 publications

References 31 publications

Hyperchloremia Is Associated With Poorer Outcome in Critically Ill Stroke Patients

Hyperchloremia Is Associated With Poorer Outcome in Critically Ill Stroke Patients

An Association Between Hyperchloremia and Acute Kidney Injury in Patients With Acute Ischemic Stroke

Hyperchloremia and postoperative acute kidney injury: a retrospective analysis of data from the surgical intensive care unit

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