Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients

Abstract

Purpose We sought to describe the association between serum chloride levels and mortality among unselected cardiac intensive care unit (CICU) patients. Materials and methods We retrospectively reviewed adult patients admitted to our CICU from 2007 to 2015. The association of dyschloremia and hospital mortality was assessed in a multiple variable model including additional confounders, and the association of dyschloremia and post-discharge mortality were assessed using Cox proportional-hazards analysis. Results 9,426 patients with a mean age of 67±15 years (37% females) were included. Admission hypochloremia was present in 1,384 (15%) patients, and hyperchloremia was present in 1,606 (17%) patients. There was a U-shaped relationship between admission chloride and unadjusted hospital mortality, with increased hospital mortality among patients with hypochloremia (unadjusted OR 3.0, 95% CI 2.5–3.6, p<0.001) or hyperchloremia (unadjusted OR 1.9, 95% CI 1.6–2.3, p<0.001). After multivariate adjustment, hypochloremia remained associated with higher hospital mortality (adjusted OR 2.1, 95% CI 1.6–2.9, p <0.001). Post-discharge mortality among hospital survivors was higher among patients with admission hypochloremia (adjusted HR 1.3, 95% CI 1.1–1.6; p<0.001). Conclusion Abnormal serum chloride on admission to the CICU is associated with increased short- and long-term mortality, with hypochloremia being a strong independent predictor.

Association between serum chloride levels with mortality in critically ill patients with acute kidney injury: An observational multicenter study employing the eICU database

“…Dyschloremia (both hypochloremia and hyperchloremia) is common in critically ill patients; it is attributable to various etiological factors or treatments [7]. Dyschloremia has also been associated with worse outcomes among patients in ICUs or coronary care units [9][10][11]. Importantly, dyschloremia is an independent prognostic predictor of hypertensive patients [12], decompensated cirrhosis [13], chronic heart failure [14], and CKD [15], as well as pediatric patients [16].…”

Trastornos electrolíticos inducidos por diuréticos de asa en los adultos mayores. Revisión sistemática

“…Se considera a la hipocloremia como un marcador independiente de mortalidad a corto y largo plazo entre los pacientes con insuficiencia cardíaca (ICC) y predice una disminución de la respuesta a los diuréticos (36,37). Mientras que la hipercloremia (niveles altos de cloruro), es frecuente por el uso indiscriminado de soluciones intravenosas con un alto contenido en cloruros y pacientes que presentan shock séptico o sepsis.…”

Mortality Prediction in Cardiac Intensive Care Unit Patients: A Systematic Review of Existing and Artificial Intelligence Augmented Approaches

“…As emphasized by M-CARS, abnormalities in common laboratory tests at the time of CICU admission have been associated with higher mortality, including hyponatremia, hyperkalemia, hypochloremia, hypoalbuminemia, anemia, elevated RDW, elevated anion gap, and elevated BUN (Jentzer et al, 2019a ; Breen et al, 2020 , 2021b ; Rayes et al, 2020 ; Padkins et al, 2021 ). One variable utilized in the M-CARS requires further clarification—the Braden skin score, which is a bedside nursing tool used to predict the risk of skin pressure injury.…”