ArticleIntensive care medicine2014
Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS.
Article in Intensive care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03630224 (Renal Effects of Fluid Resuscitation With Plasmalyte Viaflo Versus Saline in Trauma Patients), which is not on this map. Cited by 95 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Renal Effects of Fluid Resuscitation With Plasmalyte Viaflo Versus Saline in Trauma Patients (the ASTRAU Study)
Who cites it
95 citing papers in PubMed, 3 syntheses or guidelines pooled it, 213 citations in OpenAlex.
- Buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children.The Cochrane database of systematic reviews · 2026Pooled it
- Buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children.The Cochrane database of systematic reviews · 2019Pooled it
- Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 : Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine.Intensive care medicine · 2017Pooled it
- Evaluation of the effects of Plasma-Lyte 148 or 0.9% saline on acid-base balance in patients undergoing neurosurgery: a randomized clinical trial.Einstein (Sao Paulo, Brazil) · 2026Trial
- Impact of continuous hypertonic (NaCl 20%) saline solution on renal outcomes after traumatic brain injury (TBI): a post hoc analysis of the COBI trial.Critical care (London, England) · 2023Trial
- Restrictive fluids versus standard care in adults with sepsis in the emergency department (REFACED): A multicenter, randomized feasibility trial.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2022Trial
- Effect of Smartphone App-Based Education on Clinician Prescribing Habits in a Learning Health Care System: A Randomized Cluster Crossover Trial.JAMA network open · 2022Trial
- Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis: A Subgroup Analysis of Cluster Randomized Clinical Trials.JAMA network open · 2020Trial
- Normal Saline Solution and Lactated Ringer's Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial.Annals of emergency medicine · 2019Trial
- Balanced Crystalloids versus Saline in Critically Ill Adults.The New England journal of medicine · 2018Trial
- Balanced Crystalloids versus Saline in Noncritically Ill Adults.The New England journal of medicine · 2018Trial
- Balanced Crystalloids versus Saline in the Intensive Care Unit. The SALT Randomized Trial.American journal of respiratory and critical care medicine · 2017Trial
- Trial
- Trial
- Dyschloremia Is a Risk Factor for the Development of Acute Kidney Injury in Critically Ill Patients.PloS one · 2016Trial
- Statistical analysis plan for the Balanced Solution versus Saline in Intensive Care Study (BaSICS).Revista Brasileira de terapia intensivaTrial
- Development and validation of an interpretable machine learning model using routine laboratory biomarkers to stratify severe pneumonia risk in young children.Journal of advanced research · 2026Article
- Chloremia Disturbances in Critical Care: A Narrative Review of Pathophysiology, Clinical Impact and Management Strategies.Life (Basel, Switzerland) · 2026Review
- Development and Validation of a Machine Learning Model for Early Prediction of Acute Kidney Injury in Neurocritical Care: A Comparative Analysis of XGBoost, GBM, and Random Forest Algorithms.Diagnostics (Basel, Switzerland) · 2025Article
- Prevalence and Prognostic Significance of Chloride Levels in Patients with Acute Medical Conditions: A Prospective Observational Study.Life (Basel, Switzerland) · 2025Article
35 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeRecent data suggest that both elevated serum chloride levels and volume overload may be harmful during fluid resuscitation. The purpose of this study was to examine the relationship between the intravenous chloride load and in-hospital mortality among patients with systemic inflammatory response syndrome (SIRS), with and without adjustment for the crystalloid volume administered.
methodsWe conducted a retrospective analysis of 109,836 patients ≥ 18 years old that met criteria for SIRS and received fluid resuscitation with crystalloids. We examined the association between changes in serum chloride concentration, the administered chloride load and fluid volume, and the 'volume-adjusted chloride load' and in-hospital mortality.
resultsIn general, increases in the serum chloride concentration were associated with increased mortality. Mortality was lowest (3.7%) among patients with minimal increases in serum chloride concentration (0-10 mmol/L) and when the total administered chloride load was low (3.5% among patients receiving 100-200 mmol; P < 0.05 versus patients receiving ≥ 500 mmol). After controlling for crystalloid fluid volume, mortality was lowest (2.6%) when the volume-adjusted chloride load was 105-115 mmol/L. With adjustment for severity of illness, the odds of mortality increased (1.094, 95% CI 1.062, 1.127) with increasing volume-adjusted chloride load (≥ 105 mmol/L).
conclusionsAmong patients with SIRS, a fluid resuscitation strategy employing lower chloride loads was associated with lower in-hospital mortality. This association was independent of the total fluid volume administered and remained significant after adjustment for severity of illness, supporting the hypothesis that crystalloids with lower chloride content may be preferable for managing patients with SIRS.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.