Mortality and hyperchloremia in the intensive care unit

Medina-Lombo, Ronald Antonio; Sánchez-García, Víctor Leonardo; Gómez-Gómez, Luisa Fernanda; Vidal-Bonilla, Silvio Andrés; Castro-Castro, Juan José; Sánchez-Vanegas, Guillermo

doi:10.1097/cj9.0000000000000069

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…NS is known to cause hyperchloremia, especially in large volumes, due to its supraphysiologic amount of chloride [ 27 , 36 ]. Studies have shown an independent association between worsening hyperchloremia and mortality [ 37 , 38 ]. In addition, many animal and human studies have shown that hyperchloremia induced from NS leads to renal hypoperfusion and subsequent AKI [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis

Beran

Altorok

Srour

et al. 2022

JCM

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The crystalloid fluid of choice in sepsis remains debatable. We aimed to perform a comprehensive meta-analysis to compare the effect of balanced crystalloids (BC) vs. normal saline (NS) in adults with sepsis. A systematic search of PubMed, EMBASE, and Web of Sciences databases through 22 January 2022, was performed for studies that compared BC vs. NS in adults with sepsis. Our outcomes included mortality and acute kidney injury (AKI), need for renal replacement therapy (RRT), and ICU length of stay (LOS). Pooled risk ratio (RR) and mean difference (MD) with the corresponding 95% confidence intervals (CIs) were obtained using a random-effect model. Fifteen studies involving 20,329 patients were included. Overall, BC showed a significant reduction in the overall mortality (RR 0.88, 95% CI 0.81–0.96), 28/30-day mortality (RR 0.87, 95% CI 0.79–0.95), and AKI (RR 0.85, 95% CI 0.77–0.93) but similar 90-day mortality (RR 0.96, 95% CI 0.90–1.03), need for RRT (RR 0.91, 95% CI 0.76–1.08), and ICU LOS (MD −0.25 days, 95% CI −3.44, 2.95), were observed between the two groups. However, subgroup analysis of randomized controlled trials (RCTs) showed no statistically significant differences in overall mortality (RR 0.92, 95% CI 0.82–1.02), AKI (RR 0.71, 95% CI 0.47–1.06), and need for RRT (RR 0.71, 95% CI 0.36–1.41). Our meta-analysis demonstrates that overall BC was associated with reduced mortality and AKI in sepsis compared to NS among patients with sepsis. However, subgroup analysis of RCTs showed no significant differences in both overall mortality and AKI between the groups. There was no significant difference in the need for RRT or ICU LOS between BC and NS. Pending further data, our study supports using BC over NS for fluid resuscitation in adults with sepsis. Further large-scale RCTs are necessary to validate our findings.

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Section: Discussionmentioning

confidence: 99%

Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis

Beran

Altorok

Srour

et al. 2022

JCM

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“…Many studies have shown that an increased mortality ratio might be associated with elevated serum chloride levels in patients with major trauma. 15 , 16 Hyperchloremia can be harmful to tissues, causing an iatrogenic threat to the metabolic energy of cells and contributing to the risk of mortality and morbidity. 17 However, avoiding excessive serum chloride overload is necessary.…”

Section: Discussionmentioning

confidence: 99%

Effect of hyperchloremia on mortality of pediatric trauma patients: a retrospective cohort study

Çeleğen,

Çeleğen

2024

Sao Paulo Med. J.

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BACKGROUND: Hyperchloremia is often encountered due to the frequent administration of intravenous fluids in critically ill patients with conditions such as shock or hypotension in the pediatric intensive care unit, and high serum levels of chloride are associated with poor clinical outcomes. OBJECTIVES: This study aimed to determine the association between hyperchloremia and in-hospital mortality in pediatric patients with major trauma. DESIGN AND SETTING: This retrospective cohort study was conducted at a tertiary university hospital in Turkey. METHODS: Data were collected between March 2020 and April 2022. Patients aged 1 month to 18 years with major trauma who received intravenous fluids with a concentration > 0.9% sodium chloride were enrolled. Hyperchloremia was defined as a serum chloride level > 110 mmol/L. Clinical and laboratory data were compared between the survivors and nonsurvivors. RESULTS: The mortality rate was 23% (n = 20). The incidence of hyperchloremia was significantly higher in nonsurvivors than in survivors (P = 0.05). In multivariate logistic analysis, hyperchloremia at 48 h was found to be an independent risk factor for mortality in pediatric patients with major trauma. CONCLUSIONS: In pediatric patients with major trauma, hyperchloremia at 48-h postadmission was associated with 28-day mortality. This parameter might be a beneficial prognostic indicator.

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Association of hypochloremia with mortality among patients requiring continuous renal replacement therapy

et al. 2022

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Mortality and hyperchloremia in the intensive care unit

Cited by 4 publications

References 10 publications

Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis

Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis

Effect of hyperchloremia on mortality of pediatric trauma patients: a retrospective cohort study

Association of hypochloremia with mortality among patients requiring continuous renal replacement therapy

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