Shaw Andrew D, Raghunathan Karthik, Peyerl Fred W, Munson Sibyl H, Paluszkiewicz Scott M, Schermer Carol R
Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, 1215 21st Avenue S., Suite 5160 MCE NT, Office 5163, Campus Box 8274, Nashville, TN, 37232-8274, USA,
Intensive Care Med. 2014 Dec;40(12):1897-905. doi: 10.1007/s00134-014-3505-3. Epub 2014 Oct 8.
Recent data suggest that both elevated serum chloride levels and volume overload may be harmful during fluid resuscitation. The purpose of this study was to examine the relationship between the intravenous chloride load and in-hospital mortality among patients with systemic inflammatory response syndrome (SIRS), with and without adjustment for the crystalloid volume administered.
We conducted a retrospective analysis of 109,836 patients ≥ 18 years old that met criteria for SIRS and received fluid resuscitation with crystalloids. We examined the association between changes in serum chloride concentration, the administered chloride load and fluid volume, and the 'volume-adjusted chloride load' and in-hospital mortality.
In general, increases in the serum chloride concentration were associated with increased mortality. Mortality was lowest (3.7%) among patients with minimal increases in serum chloride concentration (0-10 mmol/L) and when the total administered chloride load was low (3.5% among patients receiving 100-200 mmol; P < 0.05 versus patients receiving ≥ 500 mmol). After controlling for crystalloid fluid volume, mortality was lowest (2.6%) when the volume-adjusted chloride load was 105-115 mmol/L. With adjustment for severity of illness, the odds of mortality increased (1.094, 95% CI 1.062, 1.127) with increasing volume-adjusted chloride load (≥ 105 mmol/L).
Among patients with SIRS, a fluid resuscitation strategy employing lower chloride loads was associated with lower in-hospital mortality. This association was independent of the total fluid volume administered and remained significant after adjustment for severity of illness, supporting the hypothesis that crystalloids with lower chloride content may be preferable for managing patients with SIRS.
近期数据表明，在液体复苏过程中，血清氯水平升高和容量超负荷可能都有害。本研究的目的是探讨全身炎症反应综合征（SIRS）患者静脉输注氯负荷与住院死亡率之间的关系，同时考虑是否调整晶体液输注量。
我们对109836例年龄≥18岁且符合SIRS标准并接受晶体液液体复苏的患者进行了回顾性分析。我们研究了血清氯浓度变化、输注氯负荷和液体量以及“容量校正氯负荷”与住院死亡率之间的关联。
总体而言，血清氯浓度升高与死亡率增加相关。血清氯浓度升高最小（0 - 10 mmol/L）且总输注氯负荷较低（接受100 - 200 mmol的患者中为3.5%；与接受≥500 mmol的患者相比，P < 0.05）的患者死亡率最低（3.7%）。在控制晶体液量后，容量校正氯负荷为105 - 115 mmol/L时死亡率最低（2.6%）。在调整疾病严重程度后，随着容量校正氯负荷增加（≥105 mmol/L），死亡几率增加（1.094，95%CI 1.062，1.127）。
在SIRS患者中，采用较低氯负荷的液体复苏策略与较低的住院死亡率相关。这种关联独立于总液体输注量，并且在调整疾病严重程度后仍然显著，支持了对于SIRS患者管理，含氯量较低的晶体液可能更可取的假设。
