ArticleAnnals of intensive care2016
Impact of chloride and strong ion difference on ICU and hospital mortality in a mixed intensive care population.
Article in Annals of intensive care, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 59 citations in OpenAlex.
- Dysregulated serum chloride and clinical outcomes in critically ill adults: A systematic review and meta-analysis.PloS one · 2025Pooled it
- Hypertonic saline for fluid resuscitation in ICU patients post-cardiac surgery (HERACLES): a double-blind randomized controlled clinical trial.Intensive care medicine · 2020Trial
- 154 compared to 54 mmol per liter of sodium in intravenous maintenance fluid therapy for adult patients undergoing major thoracic surgery (TOPMAST): a single-center randomized controlled double-blind trial.Intensive care medicine · 2019Trial
- Effect of isotonic versus hypotonic maintenance fluid therapy on urine output, fluid balance, and electrolyte homeostasis: a crossover study in fasting adult volunteers.British journal of anaesthesia · 2017Trial
- Association between serum anion gap and 28-day mortality among patients admitted to the hospital with aortic dissection: a retrospective cohort study with the MIMIC-IV database.Journal of thoracic disease · 2026Article
- Best evidence for fluid resuscitation nursing in hypovolemic shock patients in emergency care based on GRADE system.Asian biomedicine : research, reviews and news · 2026Article
- Characteristics of Patients With Severe Hypochloremia in the Emergency Department: A Single Center Retrospective Study.Health science reports · 2026Article
- Article
- Chloremia Disturbances in Critical Care: A Narrative Review of Pathophysiology, Clinical Impact and Management Strategies.Life (Basel, Switzerland) · 2026Review
- Impact of fluid creep on volume and chloride load in critically ill adults: a prospective study on its prognostic significance and association with MAKE30.Renal failure · 2025Article
- Association between sodium-chloride difference at ICU admission and 30-day mortality: a retrospective cohort study of critically ill adults.BMC anesthesiology · 2025Article
- Reassessing Chloride-rich Fluid Risks.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- Electrolyte Imbalance and Its Prognostic Impact on All-Cause Mortality in ICU Patients with Respiratory Failure.Medicina (Kaunas, Lithuania) · 2025Article
- Sodium and chloride disturbances in critically ill adult patients: A protocol for a sub-study of the FLUID-ICU cohort study.Acta anaesthesiologica Scandinavica · 2025Article
- Contribution of intravenous medication diluent fluid composition on the development of dyschloremia in intensive care unit patients: A retrospective chart review.SAGE open medicine · 2025Article
- Modified del Nido cardioplegia is associated with low incidence of low main strong ion difference and hyperchloremia in pediatric patients after cardiac surgery.Journal of anesthesia · 2024Article
- Intravenous fluid therapy in accordance with kidney injury risk: when to prescribe what volume of which solution.Clinical kidney journal · 2023Review
- [Sodium-chlorine difference as a prognostic predictor in adult patients diagnosed with COVID-19].Revista medica del Instituto Mexicano del Seguro Social · 2022Article
- Serum Chloride and Mortality in patients on continuous ambulatory peritoneal dialysis: A multi-center retrospective study.EClinicalMedicine · 2021Article
- Subtyping Hyperchloremia among Hospitalized Patients by Machine Learning Consensus Clustering.Medicina (Kaunas, Lithuania) · 2021Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAbnormal chloride levels are commonly observed in critically ill patients, but their clinical relevance remains a matter of debate. We examined the association between abnormal chloremia and ICU and hospital mortality. To further refine findings and integrate them into the ongoing discussion on the detrimental effects of chloride-rich solutions, the impact of strong ion difference (SID) on the same end points was assessed.
methodsRetrospective cohort study in an academic tertiary intensive care unit on 8830 adult patients who stayed at least 24 h in the ICU was carried out. Patients admitted after elective cardiac surgery were treated as a separate subgroup (n = 2350). Analyses were performed using multivariable logistic regression. All statistical models were extensively adjusted for confounders, including comorbidity, admission diagnosis, other electrolytes and acid-base parameters.
resultsSevere hyperchloremia (>110 mmol/L), but not low (SID) was significantly associated with increased mortality in the ICU (odds ratio vs. normochloremia 1.81; 95 % CI 1.32-2.50; p < 0.001) and the hospital (odds ratio 1.49; 95 % CI 1.14-1.96; p = 0.003). Hyperchloremia and low (SID) were encountered in the majority of patients admitted after cardiac surgery (in 86.9 and 47.2 %, respectively), but were not negatively associated with mortality.
conclusionsIn the ICU, hyperchloremia at admission was associated with negative outcome. On the other hand, decreased strong ion difference did not have an impact on mortality, precluding a simple extrapolation of these findings to the ongoing discussion on the detrimental effects of chloride-rich solutions. This notion is fueled by the finding that hyperchloremia after cardiac surgery, frequently encountered and probably fluid-induced, did not seem to be deleterious.
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Registered trials
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