Journal article
Increase in chloride from baseline is independently associated with mortality in critically ill children
Intensive care medicine, Vol.44(12), pp.2183-2191
2018
DOI: 10.1007/s00134-018-5424-1
PMID: 30382307
Abstract
Purpose
To determine if there is an association between mortality and admission chloride levels and/or increases in the chloride level in critically ill children.
Methods
We performed a retrospective cohort study of all patients admitted to the paediatric intensive care unit (PICU) from January 2014 to December 2015. Patients were excluded for the following reasons: (1) age < 90 days or > 18 years, (2) admission to the cardiac intensive care unit, (3) no laboratory values upon admission to the PICU, (4) history of end-stage renal disease, (5) a disorder of chloride transport, and (6) admission for diabetic ketoacidosis. The patients were stratified on the basis of admission chloride levels (hypochloraemia, < 96 mEq/L; normochloraemia, 96–109 mEq/L; and hyperchloraemia, ≥ 110 mEq/L) and dichotomised on the basis of an increase in chloride in the first day (< 5 mEq/L, ≥ 5 mEq/L). Our primary outcome was in-hospital mortality.
Results
A total of 1935 patients [55% female, median age 6.3 years IQR (1.9–13.4)] were included. The overall mortality was 4% (
n
= 71) and day 2 AKI occurred in 17% (
n
= 333. Hypochloraemia, hyperchloraemia, and an increase in serum chloride ≥ 5 mEq/L occurred in 2%, 21%, and 12%, respectively. After adjusting for confounders, increase in chloride ≥ 5 mEq/L was associated with a 2.3 (95% CI 1.03–5.21) greater odds of mortality.
Conclusions
An increase in serum chloride level in the first day of admission is common and an independent risk factor for mortality in critically ill children. Further studies are warranted to identify how chloride disturbances contribute to mortality risk in critically ill children.
Details
- Title: Subtitle
- Increase in chloride from baseline is independently associated with mortality in critically ill children
- Creators
- Matthew F. Barhight - Lurie Children's HospitalJohn Brinton - Colorado School of Public HealthTimothy Stidham - Kalispell Regional HealthcareDanielle E. Soranno - Children's Hospital ColoradoSarah Faubel - Division of Renal Disease and Hypertension, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.Benjamin R. Griffin - Division of Renal Disease and Hypertension, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.Jens Goebel - Children's Hospital ColoradoPeter M. Mourani - Children's Hospital ColoradoKatja M. Gist - Children's Hospital Colorado
- Resource Type
- Journal article
- Publication Details
- Intensive care medicine, Vol.44(12), pp.2183-2191
- Publisher
- Springer Berlin Heidelberg
- DOI
- 10.1007/s00134-018-5424-1
- PMID
- 30382307
- ISSN
- 0342-4642
- eISSN
- 1432-1238
- Language
- English
- Date published
- 2018
- Academic Unit
- Nephrology; Internal Medicine
- Record Identifier
- 9984359856602771
Metrics
17 Record Views