ArticlePloS one2017
Chloride alterations in hospitalized patients: Prevalence and outcome significance.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 60 citations in OpenAlex.
- Dysregulated serum chloride and clinical outcomes in critically ill adults: A systematic review and meta-analysis.PloS one · 2025Pooled it
- Article
- Diagnostic threshold and performance of anion gap in screening for high anion gap metabolic acidosis.Singapore medical journal · 2026Article
- Chloremia Disturbances in Critical Care: A Narrative Review of Pathophysiology, Clinical Impact and Management Strategies.Life (Basel, Switzerland) · 2026Review
- Evaluation of the effect of hyperchloremia on the prognosis and mortality of medical intensive care patients: a single-center study.Turkish journal of medical sciences · 2022Article
- Increase in chloride from baseline is independently associated with mortality in intracerebral hemorrhage patients admitted to intensive care unit: A retrospective study.Journal of intensive medicine · 2022Article
- Pediatric Mortality and Acute Kidney Injury Are Associated with Chloride Abnormalities in Intensive Care Units in the United States: A Multicenter Observational Study.Journal of pediatric intensive care · 2022Article
- Electrolyte imbalance in infectious disease patients at King Abdulaziz Hospital, Jeddah.Journal of Taibah University Medical Sciences · 2022Article
- Subtyping Hyperchloremia among Hospitalized Patients by Machine Learning Consensus Clustering.Medicina (Kaunas, Lithuania) · 2021Article
- Chloride Ion Is Not the Enemy.Critical care explorations · 2021Article
- Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients.PloS one · 2021Article
- Increased mortality risk associated with serum sodium variations and borderline hypo- and hypernatremia in hospitalized adults.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2020Article
- Hospital-Acquired Serum Chloride Derangements and Associated In-Hospital Mortality.Medicines (Basel, Switzerland) · 2020Article
- Serum Chloride Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients.Medical sciences (Basel, Switzerland) · 2020Article
- Hyperchloremia and acute kidney injury: a retrospective observational cohort study on a general mixed medical-surgical not ICU-hospitalized population.Internal and emergency medicine · 2020Observational
- A deep learning backcasting approach to the electrolyte, metabolite, and acid-base parameters that predict risk in ICU patients.PloS one · 2020Article
- Acetazolamide as a potent chloride-regaining diuretic: short- and long-term effects, and its pharmacologic role under the 'chloride theory' for heart failure pathophysiology.Heart and vessels · 2019Observational
- Urgent need for a randomized controlled trial with only septic patients!Annals of intensive care · 2019Article
- Acid-Base Disturbances in Patients with Asthma: A Literature Review and Comments on Their Pathophysiology.Journal of clinical medicine · 2019Review
- Multivariable analysis of the association between electrolyte disturbances and mortality in cats.Journal of feline medicine and surgery · 2018Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Serum Cl (sCl) alterations in hospitalized patients have not been comprehensively studied in recent years. The aim of this study is to investigate the prevalence and outcome significance of (1) sCl alterations on hospital admission, and (2) sCl evolution within the first 48 hr of hospital admission. We conducted a retrospective study of all hospital admissions in the years 2011-2013 at Mayo Clinic Rochester, a 2000-bed tertiary medical center. Outcome measures included hospital mortality, length of hospital stay and discharge disposition. 76,719 unique admissions (≥18 years old) were studied. Based on hospital mortality, sCl in the range of 105-108 mmol/L was found to be optimal. sCl <100 (n = 13,611) and >108 (n = 11,395) mmol/L independently predicted a higher risk of hospital mortality, longer hospital stay and being discharged to a care facility. 13,089 patients (17.1%) had serum anion gap >12 mmol/L; their hospital mortality, when compared to 63,630 patients (82.9%) with anion gap ≤12 mmol/L, was worse. Notably, patients with elevated anion gap displayed a progressively worsening mortality with rising sCl. sCl elevation within 48 hr of admission was associated with a higher proportion of 0.9% saline administration and was an independent predictor for hospital mortality. Moreover, the magnitude of sCl rise was inversely correlated to the days of patient survival. In conclusion, serum Cl alterations on admission predict poor clinical outcomes. Post-admission sCl increase, due to Cl-rich fluid infusion, independently predicts hospital mortality. These results raise a critical question of whether iatrogenic cause of hyperchloremia should be avoided, a question to be addressed by future prospective studies.
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Registered trials
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