需要持续肾脏替代治疗的患者中低氯血症与死亡率的关联。

Association of hypochloremia with mortality among patients requiring continuous renal replacement therapy.

作者信息

Thongprayoon Charat, Radhakrishnan Yeshwanter, Cheungpasitporn Wisit, Petnak Tananchai, Zabala Genovez Jose, Chewcharat Api, Qureshi Fawad, Mao Michael A, Kashani Kianoush B

机构信息

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

出版信息

J Nephrol. 2023 Jan;36(1):161-170. doi: 10.1007/s40620-022-01305-0. Epub 2022 Mar 26.

DOI:10.1007/s40620-022-01305-0

PMID:35347649

Abstract

BACKGROUND

Serum chloride derangement is common in critically ill patients requiring continuous renal replacement therapy (CRRT). We aimed to assess the association between serum chloride levels before and during CRRT with mortality.

METHODS

This is a retrospective cohort study of critically ill patients receiving CRRT for acute kidney injury from December 2006 through November 2015 in a tertiary referral hospital in the United States. We used logistic regression to assess serum chloride before and mean serum chloride during CRRT as predictors for 90 days mortality after CRRT initiation. The normal reference range for serum chloride was 99-108 mmol/L.

RESULTS

Of 1282 eligible patients, 25%, 50%, and 25% had hypochloremia, normochloremia, and hyperchloremia, respectively. The adjusted odds ratio for 90 days mortality in patients with hypochloremia before CRRT was 1.82 (95% CI 1.29-2.55). During CRRT, 4%, 70%, 26% of patients had mean serum chloride in the hypochloremia, normochloremia, and hyperchloremia range, respectively. The adjusted odds ratio for 90 days mortality in patients with mean serum chloride during CRRT in the hypochloremia range was 2.96 (95% CI 1.43-6.12). Hyperchloremia before and during CRRT was not associated with mortality. The greater serum chloride range during CRRT was associated with increased mortality (OR 1.29; 95% CI 1.13-1.47 per 5 mmol/L increase).

CONCLUSION

Hypochloremia before and during CRRT is associated with higher mortality.

摘要

背景

血清氯紊乱在需要持续肾脏替代治疗（CRRT）的危重症患者中很常见。我们旨在评估CRRT前和CRRT期间血清氯水平与死亡率之间的关联。

方法

这是一项对2006年12月至2015年11月在美国一家三级转诊医院因急性肾损伤接受CRRT的危重症患者进行的回顾性队列研究。我们使用逻辑回归评估CRRT前的血清氯和CRRT期间的平均血清氯作为CRRT开始后90天死亡率的预测因素。血清氯的正常参考范围是99 - 108 mmol/L。

结果

在1282例符合条件的患者中，分别有25%、50%和25%患有低氯血症、正常氯血症和高氯血症。CRRT前低氯血症患者90天死亡率的调整优势比为1.82（95%可信区间1.29 - 2.55）。在CRRT期间，分别有4%、70%、26%的患者平均血清氯处于低氯血症、正常氯血症和高氯血症范围。CRRT期间平均血清氯处于低氯血症范围的患者90天死亡率的调整优势比为2.96（95%可信区间1.43 - 6.12）。CRRT前和期间的高氯血症与死亡率无关。CRRT期间更大的血清氯范围与死亡率增加相关（每增加5 mmol/L，优势比1.29；95%可信区间1.13 - 1.47）。