Department of Pharmacy, 12280Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
Department of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, 12280Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
J Intensive Care Med. 2020 Nov;35(11):1307-1313. doi: 10.1177/0885066619865469. Epub 2019 Jul 25.
Hyperchloremia is associated with worsened outcomes in various clinical situations; however, data are limited in patients with diabetic ketoacidosis (DKA). The purpose of this study was to determine the effect of hyperchloremia on time to DKA resolution.
We conducted a retrospective cohort study of adult patients admitted with incident DKA from January 2013 through October 2017 and stratified by the development of hyperchloremia versus maintaining normochloremia. The primary outcome was time to final DKA resolution. Secondary outcomes included time to initial DKA resolution, incidence of acute kidney injury (AKI) on admission, in-hospital development of AKI, and hospital length of stay (LOS).
Of the 102 patients included, 52 developed hyperchloremia. Patients with hyperchloremia had longer times to final DKA resolution compared to those with normochloremia (median 22.3 [interquartile range, IQR, 15.2-36.9] vs 14.2 [IQR 8.8-21.1] hours; = .001). Time to initial DKA resolution was also longer in patients who developed hyperchloremia compared to those who did not (median 16.3 vs 10.9 hours; = .024). More patients with hyperchloremia developed in-hospital AKI (26.9% vs 8.0%; = .01). Median hospital LOS was significantly longer in the hyperchloremia cohort ( < .001). On Cox regression analysis, time to DKA resolution was significantly longer with each 1 mmol/L increase in serum chloride (HR 0.951; < .001).
The presence of hyperchloremia in patients with DKA was associated with increased time to DKA resolution, risk of in-hospital AKI, and hospital LOS. Further evaluation of the avoidance or treatment of hyperchloremia in DKA is needed.
高氯血症与各种临床情况下的预后恶化相关；然而，在糖尿病酮症酸中毒（DKA）患者中的数据有限。本研究的目的是确定高氯血症对 DKA 缓解时间的影响。
我们进行了一项回顾性队列研究，纳入了 2013 年 1 月至 2017 年 10 月期间因新发 DKA 入院的成年患者，并根据是否发生高氯血症与维持正常氯血症进行分层。主要结局是最终 DKA 缓解的时间。次要结局包括初始 DKA 缓解的时间、入院时急性肾损伤（AKI）的发生率、住院期间发生 AKI 和住院时间（LOS）。
在纳入的 102 例患者中，有 52 例发生高氯血症。与正常氯血症患者相比，高氯血症患者的最终 DKA 缓解时间更长（中位数 22.3 [四分位距，IQR，15.2-36.9] 与 14.2 [IQR 8.8-21.1] 小时； =.001）。与未发生高氯血症的患者相比，发生高氯血症的患者的初始 DKA 缓解时间也更长（中位数 16.3 与 10.9 小时； =.024）。更多高氯血症患者发生院内 AKI（26.9%与 8.0%； =.01）。高氯血症组的中位住院 LOS 明显更长（ <.001）。在 Cox 回归分析中，血清氯每增加 1 mmol/L，DKA 缓解时间显著延长（HR 0.951； <.001）。
DKA 患者存在高氯血症与 DKA 缓解时间延长、院内 AKI 风险增加和住院 LOS 延长相关。需要进一步评估 DKA 中避免或治疗高氯血症的方法。
