Gwak Dong-Seok, Chung Inyoung, Kim Baik-Kyun, Lee Sukyoon, Jeong Han-Gil, Kim Yong Soo, Chae Heeyun, Park Chan-Young, Han Moon-Ku
Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea.
Department of Neurology, Nowon Eulji Medical Center, Seoul, South Korea.
Front Neurol. 2021 May 20;12:604686. doi: 10.3389/fneur.2021.604686. eCollection 2021.
In general, disease severity has been found to be associated with abnormal chloride levels in critically ill patients, but hyperchloremia is associated with mixed results regarding patient-centered clinical outcomes. We aimed to investigate the impact of maximum serum chloride concentration on the clinical outcomes of critically ill patients with large hemispheric infarction (LHI). We conducted a retrospective observational cohort study using prospective institutional neurocritical care registry data from 2013 to 2018. Patients with LHIs involving over two-thirds of middle cerebral artery territory, with or without infarction of other vascular territories, and a baseline National Institutes of Health Stroke Scale score of ≥13 were assessed. Those with a baseline creatinine clearance of <15 mL/min and required neurocritical care for <72 h were excluded. Primary outcome was in-hospital mortality. Secondary outcomes included 3-month mortality and acute kidney injury (AKI) occurrence. Outcomes were compared to different maximum serum chloride levels (5 mmol/L increases) during the entire hospitalization period using multivariable logistic regression analyses. Of 90 patients, 20 (22.2%) died in-hospital. Patients who died in-hospital had significantly higher maximum serum chloride levels than did those who survived up to hospital discharge (139.7 ± 8.1 vs. 119.1 ± 10.4 mmol/L; < 0.001). After adjusting for age, sex, and Glasgow coma scale score, each 5-mmol/L increase in maximum serum chloride concentration was independently associated with an increased risk of in-hospital mortality (adjusted odds ratio (aOR), 4.34; 95% confidence interval [CI], 1.98-9.50; < 0.001). Maximum serum chloride level was also an independent risk factor for 3-month mortality (aOR, 1.99 [per 5 mmol/L increase]; 95% CI, 1.42-2.79; < 0.001) and AKI occurrence (aOR, 1.57 [per 5 mmol/L increase]; 95% CI, 1.18-2.08; = 0.002). High maximum serum chloride concentrations were associated with poor clinical outcomes in critically ill patients with LHI. This study highlights the importance of monitoring serum chloride levels and avoiding hyperchloremia in this patient population.
一般而言，已发现危重症患者的疾病严重程度与氯离子水平异常相关，但高氯血症与以患者为中心的临床结局的关系结果不一。我们旨在研究最高血清氯化物浓度对大面积半球梗死（LHI）危重症患者临床结局的影响。我们使用2013年至2018年前瞻性机构神经重症监护登记数据进行了一项回顾性观察队列研究。评估了大脑中动脉区域超过三分之二发生LHI、有或无其他血管区域梗死且美国国立卫生研究院卒中量表基线评分≥13的患者。排除基线肌酐清除率<15 mL/分钟且需要神经重症监护<72小时的患者。主要结局是院内死亡率。次要结局包括3个月死亡率和急性肾损伤（AKI）的发生情况。使用多变量逻辑回归分析比较整个住院期间不同最高血清氯化物水平（每增加5 mmol/L）的结局。90例患者中，20例（22.2%）死于院内。院内死亡患者的最高血清氯化物水平显著高于存活至出院的患者（139.7±8.1 vs. 119.1±10.4 mmol/L；P<0.001）。在调整年龄、性别和格拉斯哥昏迷量表评分后，最高血清氯化物浓度每增加5 mmol/L均与院内死亡风险增加独立相关（调整优势比（aOR），4.34；95%置信区间[CI]，1.98 - 9.50；P<0.001）。最高血清氯化物水平也是3个月死亡率（aOR，1.99[每增加5 mmol/L]；95% CI，1.42 - 2.79；P<0.001）和AKI发生（aOR，1.57[每增加5 mmol/L]；95% CI，1.18 - 2.08；P = 0.002）的独立危险因素。高最高血清氯化物浓度与LHI危重症患者的不良临床结局相关。本研究强调了在该患者群体中监测血清氯化物水平并避免高氯血症的重要性。
