Ma Quan, Tian Wei, Wang Kaifeng, Xu Bin, Lou Tianyu
Department of Urology, Shaoxing Central Hospital, Shaoxing, Zhejiang, 312030, China.
Department of Intensive Care Unit, Shaoxing Central Hospital, Shaoxing, Zhejiang, 312030, China.
BMC Anesthesiol. 2025 Jan 3;25(1):3. doi: 10.1186/s12871-024-02870-6.
This study explores the association between serum chloride concentrations and all-cause mortality among patients in the Surgical Intensive Care Unit (SICU). Employing a retrospective cohort design, the study utilized data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, specifically focusing on individuals admitted to the surgical/trauma ICUs. This dataset encompassed demographic profiles, laboratory findings, historical medical data, vital statistics, and variables pertinent to prognosis. Participants were divided into four groups based on their serum chloride concentrations. The primary outcomes assessed were mortality rates at 30, 90, and 180 days post-admission to the ICU. Analytical methods included Kaplan-Meier survival curves, Cox proportional hazards regression models, and Restricted Cubic Spline (RCS) analyses to delineate the relationship between serum chloride concentrations and patient outcomes. The study cohort comprised 10,996 patients, with observed mortality rates of 12.78% at 30 days, 17.14% at 90 days, and 20.32% at 180 days. Kaplan-Meier analyses revealed significant disparities in survival rates across the quartiles of serum chloride during the follow-up intervals (p < 0.001). The results from the multivariable Cox regression suggested a substantial inverse association between high serum chloride levels and decreased mortality at 30 days (hazard ratio [HR]: 0.96; 95%confidence interval [CI]: 0.95-0.97; P < 0.001), 90 days (HR: 0.97; 95% CI: 0.96-0.98; P < 0.001), and 180 days (HR: 0.97; 95% CI: 0.96-0.98; P < 0.001). Particularly, patients in the highest quartile of serum chloride faced significantly lower mortality risks compared to those in the lowest quartile (30 days HR = 0.65, 90 days HR = 0.71, 180 days HR = 0.69, P < 0.001). RCS analysis depicted an L-shaped curve demonstrating the dynamics between serum chloride concentrations and the risk of all-cause mortality across the 30-day, 90-day, and 180-day periods.Starting at a concentration of 104 mmol/L, a decrease in serum chloride levels was associated with an increased risk of mortality.These findings elucidate a marked nonlinear association between serum chloride levels and all-cause mortality in SICU patients, enhancing our comprehension of serum chloride's impact on clinical outcomes in this setting.
本研究探讨了外科重症监护病房（SICU）患者血清氯浓度与全因死亡率之间的关联。该研究采用回顾性队列设计，利用从重症监护医学信息集市IV（MIMIC-IV）数据库中提取的数据，特别关注入住外科/创伤重症监护病房的患者。该数据集包括人口统计学资料、实验室检查结果、既往病史、生命统计数据以及与预后相关的变量。参与者根据血清氯浓度分为四组。评估的主要结局是入住ICU后30天、90天和180天的死亡率。分析方法包括Kaplan-Meier生存曲线、Cox比例风险回归模型和限制性立方样条（RCS）分析，以描述血清氯浓度与患者结局之间的关系。研究队列包括10996名患者，观察到的30天死亡率为12.78%，90天死亡率为17.14%，180天死亡率为20.32%。Kaplan-Meier分析显示，在随访期间，血清氯四分位数之间的生存率存在显著差异（p<0.001）。多变量Cox回归结果表明，高血清氯水平与30天（风险比[HR]：0.96；95%置信区间[CI]：0.95-0.97；P<0.001）、90天（HR：0.97；95%CI：0.96-0.98；P<0.001）和180天（HR：0.97；95%CI：0.96-0.98；P<0.001）死亡率降低之间存在显著的负相关。特别是，血清氯最高四分位数的患者与最低四分位数的患者相比，面临的死亡风险显著降低（30天HR=0.65，90天HR=0.71，180天HR=0.69，P<0.001）。RCS分析描绘了一条L形曲线，展示了血清氯浓度与30天、90天和180天期间全因死亡风险之间的动态关系。从104mmol/L的浓度开始，血清氯水平的降低与死亡风险的增加相关。这些发现阐明了SICU患者血清氯水平与全因死亡率之间显著的非线性关联，增强了我们对血清氯在这种情况下对临床结局影响的理解。
