Thanekar Saurabh M, Shanbhag Vishal, Prabhu Attur Ravindra, Nagaraju Shankar Prasad, Rangaswamy Dharshan, Shenoy Srinivas Vinayak, Bhojaraja Mohan Varadarayanahalli, Rao Indu Ramachandra
Department of Nephrology Kasturba Medical College Manipal Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
Department of Critical Care Kasturba Medical College Manipal Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
Crit Care Res Pract. 2024 Oct 1;2024:8848405. doi: 10.1155/2024/8848405. eCollection 2024.
Chloride is the most abundant extracellular anion; however, abnormalities of serum chloride (dyschloremia) are often overlooked. This study aimed to study the association of dyschloremia with AKI and major adverse kidney events at Day 30 (MAKE30) in critically ill patients with sepsis. This prospective single-center cohort study included adult patients with sepsis admitted in a tertiary care hospital in India. Patients with advanced chronic kidney disease, requiring dialysis at admission, or with hospital stay of less than 72 h were excluded. Hyperchloremia and hypochloremia were defined as chloride levels of > 110 mEq/L and < 95 mEq/L, respectively. The primary outcome measure was MAKE30-a composite of death, need for dialysis, or sustained loss of kidney function at Day 30. In a cohort of 400 patients with a mean age of 60 (±15) years, AKI was seen in 301 (75.2%) and MAKE30 in 171 (42.8%). Hyperchloremia and hypochloremia were seen in 19.3% ( = 77) and 32.3% ( = 129), respectively, in the first 72 h of ICU stay. Hypochloremia, but not hyperchloremia, was independently associated with both MAKE30 (OR: 2.56, 95% CI: 1.13-5.79; =0.024) and new-onset or worsening AKI (OR: 2.52, 95% CI: 1.17-5.41; =0.019). There was no association between hyperchloremia and either MAKE30 (OR: 1.07, 95% CI: 0.43-2.69; =0.882) or new-onset/worsening AKI (OR: 0.89, 95% CI: 0.38-2.09; =0.781). Hypochloremia, but not hyperchloremia, was associated with MAKE30 in this cohort of critically ill patients with sepsis. Clinical Trial Registry identifier: CTRI//2022/02/040519.
氯离子是细胞外最丰富的阴离子；然而，血清氯异常（氯代谢紊乱）常常被忽视。本研究旨在探讨脓毒症重症患者中氯代谢紊乱与急性肾损伤（AKI）及30天主要不良肾脏事件（MAKE30）之间的关联。这项前瞻性单中心队列研究纳入了印度一家三级护理医院收治的成年脓毒症患者。排除患有晚期慢性肾脏病、入院时需要透析或住院时间少于72小时的患者。高氯血症和低氯血症分别定义为氯水平>110 mEq/L和<95 mEq/L。主要结局指标是MAKE30，即30天时死亡、需要透析或肾功能持续丧失的综合情况。在一个平均年龄为60（±15）岁的400例患者队列中，301例（75.2%）出现AKI，171例（42.8%）出现MAKE30。在入住重症监护病房（ICU）的前72小时内，高氯血症和低氯血症的发生率分别为19.3%（n = 77）和32.3%（n = 129）。低氯血症而非高氯血症与MAKE30（比值比：2.56，95%置信区间：1.13 - 5.79；P = 0.024）和新发或恶化的AKI（比值比：2.52，95%置信区间：1.17 - 5.41；P = 0.019）均独立相关。高氯血症与MAKE30（比值比：1.07，95%置信区间：0.43 - 2.69；P = 0.882）或新发/恶化的AKI（比值比：0.89，95%置信区间：0.38 - 2.09；P = 0.781）均无关联。在这个脓毒症重症患者队列中，低氯血症而非高氯血症与MAKE30相关。临床试验注册标识符：CTRI//2022/02/040519。
