Thomas J Breen1, Benjamin Brueske2, Mandeep S Sidhu2, Kianoush B Kashani3,4, Nandan S Anavekar5, Gregory W Barsness5, Jacob C Jentzer4,5. 1. Department of Internal Medicine, Mayo Clinic, Rochester MN, United States of America. 2. Division of Cardiology, Department of Medicine, Albany Medical Center and Albany Medical College, Albany, NY, United States of America. 3. Division of Nephrology & Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America. 4. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America. 5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
Abstract
PURPOSE: We sought to describe the association between serum chloride levels and mortality among unselected cardiac intensive care unit (CICU) patients. MATERIALS AND METHODS: We retrospectively reviewed adult patients admitted to our CICU from 2007 to 2015. The association of dyschloremia and hospital mortality was assessed in a multiple variable model including additional confounders, and the association of dyschloremia and post-discharge mortality were assessed using Cox proportional-hazards analysis. RESULTS: 9,426 patients with a mean age of 67±15 years (37% females) were included. Admission hypochloremia was present in 1,384 (15%) patients, and hyperchloremia was present in 1,606 (17%) patients. There was a U-shaped relationship between admission chloride and unadjusted hospital mortality, with increased hospital mortality among patients with hypochloremia (unadjusted OR 3.0, 95% CI 2.5-3.6, p<0.001) or hyperchloremia (unadjusted OR 1.9, 95% CI 1.6-2.3, p<0.001). After multivariate adjustment, hypochloremia remained associated with higher hospital mortality (adjusted OR 2.1, 95% CI 1.6-2.9, p <0.001). Post-discharge mortality among hospital survivors was higher among patients with admission hypochloremia (adjusted HR 1.3, 95% CI 1.1-1.6; p<0.001). CONCLUSION: Abnormal serum chloride on admission to the CICU is associated with increased short- and long-term mortality, with hypochloremia being a strong independent predictor.
PURPOSE: We sought to describe the association between serum chloride levels and mortality among unselected cardiac intensive care unit (CICU) patients. MATERIALS AND METHODS: We retrospectively reviewed adult patients admitted to our CICU from 2007 to 2015. The association of dyschloremia and hospital mortality was assessed in a multiple variable model including additional confounders, and the association of dyschloremia and post-discharge mortality were assessed using Cox proportional-hazards analysis. RESULTS: 9,426 patients with a mean age of 67±15 years (37% females) were included. Admission hypochloremia was present in 1,384 (15%) patients, and hyperchloremia was present in 1,606 (17%) patients. There was a U-shaped relationship between admission chloride and unadjusted hospital mortality, with increased hospital mortality among patients with hypochloremia (unadjusted OR 3.0, 95% CI 2.5-3.6, p<0.001) or hyperchloremia (unadjusted OR 1.9, 95% CI 1.6-2.3, p<0.001). After multivariate adjustment, hypochloremia remained associated with higher hospital mortality (adjusted OR 2.1, 95% CI 1.6-2.9, p <0.001). Post-discharge mortality among hospital survivors was higher among patients with admission hypochloremia (adjusted HR 1.3, 95% CI 1.1-1.6; p<0.001). CONCLUSION: Abnormal serum chloride on admission to the CICU is associated with increased short- and long-term mortality, with hypochloremia being a strong independent predictor.
Authors: Adnan I Qureshi; Wei Huang; Daniel F Hanley; Chung Y Hsu; Renee H Martin; Kunal Malhotra; Thorsten Steiner; Jose I Suarez; Haruko Yamamoto; Kazunori Toyoda Journal: Neurocrit Care Date: 2022-05-05 Impact factor: 3.532