Serum chloride level fluctuation in the first 72 h of ICU admission is independently associated with increased 30-day mortality.

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• Hyo Jin Kim, Tak Kyu Oh, In-Ae Song, and Jae Ho Lee.
• Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik hospital, Seoul, South Korea.
• BMC Anesthesiol. 2019 May 17; 19 (1): 79.

BackgroundThis study investigated the associations of fluctuations in serum chloride (Cl-) levels with 30-day mortality after intensive care unit (ICU) admission among critically ill patients.MethodsWe retrospectively analyzed the medical records of adult patients (≥18 years old) admitted to the ICU between January 2012 and December 2017. Positive and negative fluctuations in Cl- were defined as the differences between the Cl- upon ICU admission (baseline Cl-) and the maximum and minimum Cl- levels, respectively, measured within 72 h after ICU admission.ResultsThe final analysis included 18,825 adult patients. In multivariable Cox regression analyses, the risk of 30-day mortality increased by 8% per 1-mmol L- 1 positive fluctuation in Cl- within 72 h (hazard ratio = 1.08, 95% confidence interval: 1.04-1.11, P < 0.001). In subgroup analyses, a positive fluctuation in Cl- was associated with increased 30-day mortality among patients with a severe positive cumulative fluid balance (FB, > 10%), normochloremia (97-110 mmol L- 1) or hyperchloremia (> 110 mmol L- 1) upon ICU admission. Furthermore, a negative fluctuation in the Cl- level during the first 72 h of an ICU stay was associated with a negative cumulative FB (< 0%) or hypochloremia (< 97 mmol L- 1) upon ICU admission.ConclusionsA fluctuation in the Cl- level during the first 72 h of an ICU stay was found to associate independently with increased 30-day mortality among critically ill adult patients. However, the nature of this association differed according to the cumulative FB status or dyschloremia status upon ICU admission.

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