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 mortality. 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 CHF. Similarly, another study on CAD patients confirmed that hypochloremia was linked to increased short-term and long-term mortality, emphasizing the need for early intervention.
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 rates.
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 beneficial. Another study on septic shock patients confirmed that hypochloremia was linked to higher 28-day mortality, further supporting the importance of chloride management in sepsis.
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 levels.
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 patients.
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 care.
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 assessment.
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
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 in Patients with Severe Traumatic Brain Injury: A Possible Risk Factor for Increased Mortality.
An increased chloride level in hypochloremia is associated with decreased mortality in patients with severe sepsis or septic shock
Prevalence and Mortality of Hypochloremia Among Patients with Coronary Artery Disease: A Cohort Study
The Association between the Hypochloremia and Mortality in Intensive Care Unit (ICU) Patients with Chronic Heart Failure
Prognostic Value of Hypochloremia in Critically Ill Patients With Decompensated Cirrhosis
Hypochloraemia is associated with 28-day mortality in patients with septic shock: a retrospective analysis of a multicentre prospective registry
Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients
Association of Preoperative Serum Chloride Levels With Mortality and Morbidity After Noncardiac Surgery: A Retrospective Cohort Study.
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