The Incidence and Prognostic Value of Hypochloremia in Critically Ill Patients

Tani, Makiko; Morimatsu, Hiroshi; Takatsu, Fumiaki; Morita, Kiyoshi

doi:10.1100/2012/474185

Cited by 61 publications

(77 citation statements)

References 16 publications

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“…These studies showed conflicting results and included only a small number of patients with severe sepsis or septic shock. One study in 488 critically ill patients did not show an association between Cl and mortality (21). Notably, the hospital mortality rate in this study was only 3%, precluding the ability to establish a firm conclusion.…”

Section: Discussionmentioning

confidence: 99%

Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients

Neyra

Canepa-Escaro²,

et al. 2015

Critical Care Medicine

192

164

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Objective Hyperchloremia is frequently observed in critically ill patients in the intensive care unit (ICU). Our study aimed to examine the association of serum chloride (Cl) levels with hospital mortality in septic ICU patients. Design Retrospective cohort study. Setting Urban academic medical center ICU. Patients ICU adult patients with severe sepsis or septic shock who had Cl measured on ICU admission were included. Those with baseline estimated glomerular filtration rate < 15 ml/min/1.73 m2 or chronic dialysis were excluded. Intervention: None. Measurements and Main Results Of 1940 patients included in the study, 615 (31.7%) had hyperchloremia (Cl ≥ 110 mEq/L) on ICU admission. All-cause hospital mortality was the dependent variable. Cl on ICU admission (Cl0), Cl at 72 h (Cl72), and delta Cl (ΔCl = Cl72 – Cl0) were the independent variables. Those with Cl0 ≥ 110 mEq/L were older and had higher cumulative fluid balance, base deficit, and sequential organ failure assessment scores. Multivariate analysis showed that higher Cl72 but not Cl0 was independently associated with hospital mortality in the subgroup of patients with hyperchloremia on ICU admission [adjusted odds ratio (OR) for Cl72 per 5 mEq/L increase = 1.27, 95% CI (1.02–1.59), P = 0.03]. For those who were hyperchloremic on ICU admission, every within-subject 5 mEq/L increment in Cl72 was independently associated with hospital mortality [adjusted OR for ΔCl 5 mEq/L = 1.37, 95% CI [1.11–1.69], P = 0.003]. Conclusions In critically ill septic patients manifesting hyperchloremia (Cl ≥110 mEq/L) on ICU admission, higher Cl levels and within-subject worsening hyperchloremia at 72 h of ICU stay were associated with all-cause hospital mortality. These associations were independent of base deficit, cumulative fluid balance, acute kidney injury, and other critical illness parameters.

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Section: Discussionmentioning

confidence: 99%

Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients

Neyra

Canepa-Escaro²,

et al. 2015

Critical Care Medicine

192

164

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“…Recent studies have demonstrated that hypochloremia, hyperchloremia, and dysnatremia are related to increased mortality (9)(10)(11). Nevertheless, identifying the Cl -:Na + ratio as a predictor of increased ICU mortality may be premature.…”

Section: Discussionmentioning

confidence: 99%

“…We think that this notion is most important in septic patients who have increased mortality. Rare combinations can be seen in daily clinical practice, and those combinations were also discussed in previous studies (Table 3) (6,9,13,(15)(16)(17)(18)(19). Kurt et al (15) indicated the presence of hypochloremic metabolic acidosis in 16% of acid-base disorders.…”

Section: Classification and Calculationsmentioning

confidence: 99%

“…In these patients, treatment of a low Cl -:Na + ratio without considering the respiratory component may result in severe acidosis or management of the respiratory component without taking into account the possibility that the low Cl -:Na + ratio may cause severe alkalosis. Tani et al (9) showed that in critically ill patients with hypochloremia, SID-related alkalosis can develop and the duration of ICU stay and mortality rate can increase. In this study, 90.8% of the patients were postoperative patients.…”

Section: Classification and Calculationsmentioning

confidence: 99%

“…It is indicated that a strong ion difference (SID) is related to mortality (7,8). Hypochloremia, hyperchloremia, and dysnatremia are also known to be associated with increased mortality (9)(10)(11). Thus, the Cl:Na + ratio can also be associated with increased mortality.…”

Section: Introductionmentioning

confidence: 99%

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The effects of the chloride:sodium ratio on acid-base statusand mortality in septic patients

Atalan¹,

Güçyetmez²

2017

Turk J Med Sci

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IntroductionAcid-base disorder is an important issue that requires an urgent solution in the intensive care unit (ICU) (1). Stewart's physiochemical approach provides practical solutions for the understanding of metabolic acid-base disorders (2-4). However, this approach has limitations that prevent intensivists from completing a fast bedside assessment. Therefore, methods enabling fast and accurate bedside assessment are needed. Recently, simpler and more practical approaches, such as assessments of Cland Na + differences, Cl -:Na + ratio evaluation, and base excesschloride (BE Cl ) calculations, have been used (5,6). Duward et al. (6) evaluated acid-base disorders in accordance with pH, pCO 2 , and Clchanges. According to Duward et al. (6), the main reason for the changes in the HCO 3 pool is changes in Cl -. Moreover, Clmust always be interpreted together with Na + , and the simplest method of achieving this interpretation is calculation of the Cl -:Na + ratio. Hypochloremia or hyperchloremia should be considered in accordance with the Cl -:Na + ratio. Regardless of the individual Cland Na + concentrations, the Cl -:Na + ratio may be low or high. This notion makes the contribution of Clto acid-base disorder more comprehensible. It is indicated that a strong ion difference (SID) is related to mortality (7,8). Hypochloremia, hyperchloremia, and dysnatremia are also known to be associated with increased mortality (9-11). Thus, the Cl:Na + ratio can also be associated with increased mortality. In the present study, the relationship between the Cl -:Na + ratio in septic patients at ICU admission and each of the other components of the acid-base balance and ICU mortality was investigated. Material and methods Study designEthics committee approval was obtained from the Acıbadem University Medical Research Council for the present study. A total of 2691 patients admitted to the Acıbadem International Hospital ICU and Ataşehir Memorial ICU between 1 January 2006 and 31 December 2012 were retrospectively evaluated. Patients who were Background/aim: Calculation of the chloride:sodium (Cl -:Na + ) ratio is proposed to enable a quick evaluation of the effect of Cland Na + on the acid-base balance in critically ill patients. In the present study, the relationship of the Cl -:Na + ratio of septic patients with acidbase status and ICU mortality were investigated. Materials and methods:In our two-center study, 434 patients who were diagnosed with sepsis were included. The patients were divided into three groups: low (<0.75), normal (≥0.75, <0.80), and high (≥0.80) Cl -:Na + ratio groups. Patients' demographic data, blood gas values, length of ICU stay, and ICU mortality were recorded. Results:In the low and high groups, ICU mortality was significantly higher than in the normal group (29.3%, 37.1%) (P = 0.005). There was a negative correlation between the Cl:Na + ratio and each of HCO 3 -, standard base excess, and PaCO 2 (r 2 = 0.21, r 2 = 0.19, and r 2 = 0.17) (P < 0.001 for each). In the multivariate analysis, the ICU mortal...

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Increase in chloride from baseline is independently associated with mortality in critically ill children

et al. 2018

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The Incidence and Prognostic Value of Hypochloremia in Critically Ill Patients

Cited by 61 publications

References 16 publications

Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients

Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients

The effects of the chloride:sodium ratio on acid-base statusand mortality in septic patients

Increase in chloride from baseline is independently associated with mortality in critically ill children

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