Is hypochloremia related with mortality?
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The Relationship Between Hypochloremia and Mortality
Introduction to Hypochloremia and Mortality
Hypochloremia, defined as low serum chloride levels, has been increasingly recognized as a significant marker in various medical conditions. This article synthesizes recent research findings to explore the relationship between hypochloremia and mortality across different patient populations.
Hypochloremia in Acute Kidney Injury (AKI)
In patients with acute kidney injury (AKI), hypochloremia has been associated with higher mortality rates. A study involving 243 patients with AKI stage 3 found that those with baseline chloride levels below 98 mEq/L had significantly lower survival rates and higher incidences of unplanned dialysis starts and all-cause mortality1. This suggests that monitoring and managing chloride levels in AKI patients could be crucial for improving outcomes.
Hypochloremia in Coronary Artery Disease (CAD) and Congestive Heart Failure (CHF)
Hypochloremia is also a predictor of mortality in patients with coronary artery disease (CAD) and congestive heart failure (CHF). Analysis of data from the CIN-I and MIMIC-III databases revealed that hypochloremia was independently associated with higher short-term and long-term all-cause mortality in CAD patients with CHF2. Similarly, another study on CAD patients confirmed that hypochloremia was linked to increased short-term and long-term mortality, emphasizing the need for early intervention5.
Hypochloremia in Traumatic Brain Injury (TBI)
In patients with severe traumatic brain injury (TBI), hypochloremia has been identified as a significant risk factor for increased mortality. A retrospective cohort study found a notable correlation between low chloride levels and higher mortality rates in TBI patients, suggesting that electrolyte management could play a role in improving survival rates3.
Hypochloremia in Sepsis and Septic Shock
Hypochloremia is prevalent among septic patients and is associated with increased mortality. A study involving 843 Korean septic patients found that those with hypochloremia had a higher mortality rate. However, an increase in chloride levels within 24 hours was associated with decreased mortality, indicating that timely correction of hypochloremia could be beneficial4. Another study on septic shock patients confirmed that hypochloremia was linked to higher 28-day mortality, further supporting the importance of chloride management in sepsis8.
Hypochloremia in Chronic Heart Failure (CHF)
In critically ill patients with chronic heart failure, hypochloremia has been consistently associated with increased mortality. A study from the MIMIC-IV database showed that hypochloremia significantly raised the 30-day mortality risk in CHF patients, highlighting the need for careful monitoring and potential interventions to manage chloride levels6.
Hypochloremia in Decompensated Cirrhosis
Patients with decompensated cirrhosis and hypochloremia have higher mortality rates. A study conducted in a medical ICU found that hypochloremia was independently associated with increased 180-day mortality, suggesting that serum chloride levels could be a valuable prognostic marker in cirrhotic patients7.
Hypochloremia in Cardiac Intensive Care Unit (CICU) Patients
In the cardiac intensive care unit (CICU), hypochloremia has been linked to both short-term and long-term mortality. A retrospective review of CICU patients found that those with hypochloremia had significantly higher hospital and post-discharge mortality rates, indicating the critical role of chloride levels in cardiac care9.
Hypochloremia in Noncardiac Surgery
Preoperative hypochloremia has been associated with increased postoperative mortality and morbidity in noncardiac surgery patients. A large retrospective cohort study found that patients with preoperative hypochloremia had higher 90-day mortality and an increased risk of acute kidney injury, underscoring the importance of preoperative electrolyte assessment10.
Conclusion
The evidence strongly suggests that hypochloremia is associated with increased mortality across various medical conditions, including AKI, CAD, CHF, TBI, sepsis, cirrhosis, and in both cardiac and noncardiac surgical patients. Monitoring and managing serum chloride levels could be crucial in improving patient outcomes and reducing mortality risks. Further research is needed to explore effective interventions for correcting hypochloremia and mitigating its impact on mortality.
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Most relevant research papers on this topic
#4589 HYPOCHLOREMIA AS A MARKER OF ALL-CAUSE MORTALITY AND UNPLANNED DIALYSIS STARTS IN A COHORT OF ACUTE KIDNEY INJURY: A 4-YEAR FOLLOW-UP STUDY
Baseline hypochloremia (98 mEq/L) in patients with acute kidney injury stage 3 is associated with higher overall mortality and unplanned dialysis starts.
Prevalence and Mortality of Hypochloremia Among Patients Suffering From Coronary Artery Disease and Congestive Heart Failure: An Analysis of Patients in CIN-I and MIMIC-III Databases
Hypochloremia is a significant predictor of both short-term and long-term mortality in coronary artery disease patients with congestive heart failure.
Observational StudyHypochloremia in Patients with Severe Traumatic Brain Injury: A Possible Risk Factor for Increased Mortality.
Hypochloremia is a significant risk factor for increased mortality in patients with severe traumatic brain injury, and monitoring this electrolyte disturbance may improve treatment outcomes.
Observational StudyAn increased chloride level in hypochloremia is associated with decreased mortality in patients with severe sepsis or septic shock
An increased chloride concentration within 24 hours in patients with hypochloremia is associated with a decreased mortality rate in severe septic patients.
Prevalence and Mortality of Hypochloremia Among Patients with Coronary Artery Disease: A Cohort Study
Hypochloremia is mildly common in patients with coronary artery disease and is associated with increased short- and long-term mortality.
Observational Study
Rigorous JournalThe Association between the Hypochloremia and Mortality in Intensive Care Unit (ICU) Patients with Chronic Heart Failure
Hypochloremia is associated with increased mortality in critically ill ICU patients with chronic heart failure.
Prognostic Value of Hypochloremia in Critically Ill Patients With Decompensated Cirrhosis
Hypochloremia, not hyponatremia, is an independent and inversely associated with short-term mortality in critically ill cirrhotic patients, suggesting it may account for the mortality risk previously attributed to hyponatremia.
Observational StudyHypochloraemia is associated with 28-day mortality in patients with septic shock: a retrospective analysis of a multicentre prospective registry
Hypochloraemia is more common than hyperchloraemia and is associated with higher 28-day mortality in ED patients with septic shock.
Observational StudyAbnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients
Abnormal serum chloride levels on admission to cardiac intensive care unit are associated with increased short- and long-term mortality, with hypochloremia being a strong independent predictor.
Observational StudyRigorous JournalAssociation of Preoperative Serum Chloride Levels With Mortality and Morbidity After Noncardiac Surgery: A Retrospective Cohort Study.
Preoperative hypochloremia and hyperchloremia are associated with increased 90-day mortality after noncardiac surgery, with preoperative hypochloremia also increasing the risk of acute kidney injury.
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