Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Yanta District, Xi'an, China.
BMC Anesthesiol. 2022 Jan 7;22(1):14. doi: 10.1186/s12871-021-01558-5.
Serum chloride (Cl) is one of the most essential extracellular anions. Based on emerging evidence obtained from patients with kidney or heart disease, hypochloremia has been recognized as an independent predictor of mortality. Nevertheless, excessive Cl can also cause death in severely ill patients. This study aimed to investigate the relationship between hyperchloremia and high mortality rate in patients admitted to the surgical intensive care unit (SICU).
We enrolled 2131 patients from the Multiparameter Intelligent Monitoring in Intensive Care III database version 1.4 (MIMIC-III v1.4) from 2001 to 2012. Selected SICU patients were more than 18 years old and survived more than 72 h. A serum Cl level ≥ 108 mEq/L was defined as hyperchloremia. Clinical and laboratory variables were compared between hyperchloremia (n = 664) at 72 h post-ICU admission and no hyperchloremia (n = 1467). The Locally Weighted Scatterplot Smoothing (Lowess) approach was utilized to investigate the correlation between serum Cl- and the thirty-day mortality rate. The Cox proportional-hazards model was employed to investigate whether serum chlorine at 72 h post-ICU admission was independently related to in-hospital, thirty-day and ninety-day mortality from all causes. Kaplan-Meier curve of thirty-day and ninety-day mortality and serum Cl at 72 h post-ICU admission was further constructed. Furthermore, we performed subgroup analyses to investigate the relationship between serum Cl at 72 h post-ICU admission and the thirty-day mortality from all causes.
A J-shaped correlation was observed, indicating that hyperchloremia was linked to an elevated risk of thirty-day mortality from all causes. In the multivariate analyses, it was established that hyperchloremia remained a valuable predictor of in-hospital, thirty-day and ninety-day mortality from all causes; with adjusted hazard ratios (95% CIs) for hyperchloremia of 1.35 (1.02 ~ 1.77), 1.67 (1.28 ~ 2.19), and 1.39 (1.12 ~ 1.73), respectively. In subgroup analysis, we observed hyperchloremia had a significant interaction with AKI (P for interaction: 0.017), but there were no interactions with coronary heart disease, hypertension, and diabetes mellitus (P for interaction: 0.418, 0.157, 0.103, respectively).
Hyperchloremia at 72 h post-ICU admission and increasing serum Cl were associated with elevated mortality risk from all causes in severely ill SICU patients.
血清氯（Cl）是最重要的细胞外阴离子之一。基于从患有肾脏或心脏疾病的患者中获得的新证据，低氯血症已被认为是死亡率的独立预测因素。然而，严重疾病患者的高氯血症也可能导致死亡。本研究旨在探讨外科重症监护病房（SICU）患者高氯血症与高死亡率之间的关系。
我们从 2001 年至 2012 年的多参数智能监测在重症监护 III 数据库版本 1.4（MIMIC-III v1.4）中招募了 2131 名患者。入选的 SICU 患者年龄大于 18 岁，存活时间超过 72 小时。将血清 Cl 水平≥108 mEq/L 定义为高氯血症。比较 ICU 入院后 72 小时高氯血症（n=664）和无高氯血症（n=1467）患者的临床和实验室变量。使用局部加权散点平滑（Lowess）方法探讨血清 Cl-与 30 天死亡率之间的相关性。采用 Cox 比例风险模型探讨 ICU 入院后 72 小时血清氯是否与院内、30 天和 90 天全因死亡率独立相关。进一步构建 ICU 入院后 72 小时血清 Cl 与 30 天和 90 天全因死亡率的 Kaplan-Meier 曲线。此外，我们进行了亚组分析，以探讨 ICU 入院后 72 小时血清 Cl 与全因 30 天死亡率之间的关系。
观察到 J 形相关性，表明高氯血症与全因 30 天死亡率升高有关。在多变量分析中，高氯血症仍然是院内、30 天和 90 天全因死亡率的有价值预测因子；调整后的高氯血症危险比（95%CI）分别为 1.35（1.021.77）、1.67（1.282.19）和 1.39（1.12~1.73）。在亚组分析中，我们观察到高氯血症与 AKI 有显著的交互作用（交互作用 P 值：0.017），但与冠心病、高血压和糖尿病无交互作用（交互作用 P 值：0.418、0.157、0.103）。
SICU 重症患者 ICU 入院后 72 小时高氯血症和血清 Cl 升高与全因死亡率升高相关。
