ArticleBMC gastroenterology2021
Lower serum chloride concentrations are associated with increased risk of mortality in critically ill cirrhotic patients: an analysis of the MIMIC-III database.
Article in BMC gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Serum chloride concentrations and outcomes in adult patients with cirrhosis: a systematic review and meta-analysis.BMC nephrology · 2025Pooled it
- Alcoholic Liver Disease and Systemic Inflammatory Response Syndrome: Mortality Prediction Using Biomarkers and Clinical Scores.Journal of clinical medicine · 2025Article
- Electrolyte Imbalance and Its Prognostic Impact on All-Cause Mortality in ICU Patients with Respiratory Failure.Medicina (Kaunas, Lithuania) · 2025Article
- Hypochloremia is an underutilised prognostic marker in patients with advanced liver cirrhosis and liver failure.World journal of hepatology · 2025Review
- Organ preservation: current limitations and optimization approaches.Frontiers in medicine · 2025Review
- Chloride ions in health and disease.Bioscience reports · 2024Review
- L-Shaped Association of Serum Chloride Level With All-Cause and Cause-Specific Mortality in American Adults: Population-Based Prospective Cohort Study.JMIR public health and surveillance · 2023Article
- Dietary salt in liver cirrhosis: With a pinch of salt!World journal of hepatology · 2023Review
- Interaction of hemoglobin, transfusion, and acute kidney injury in patients undergoing cardiopulmonary bypass: a group-based trajectory analysis.Renal failure · 2022Article
- Hypochloremia as a novel adverse prognostic factor in acute liver failure.Liver international : official journal of the International Association for the Study of the Liver · 2022Article
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2 authors at 1 institution in 1 country.
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Abstract
backgroundCirrhosis can be complicated by electrolyte abnormalities, but the major focus has been concentrated on the clinical significance of serum sodium levels. Emerging studies have identified hypochloremia as an independent prognostic marker in patients with chronic heart failure and chronic kidney disease. The aim of this study was to investigate whether serum chloride levels were associated with mortality of critically ill cirrhotic patients.
methodsCritically ill cirrhotic patients were identified from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. The primary outcome was ICU mortality. Logistic regression was used to explore the association between serum chloride levels and ICU mortality. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of serum chloride levels for predicting ICU mortality.
resultsA total of 1216 critically ill cirrhotic patients were enrolled in this study. The overall ICU mortality rate was 18.8%. Patients with hypochloremia had a higher ICU mortality than those with non-hypochloremia (34.2% vs. 15.8%; p < 0.001). After multivariable risk adjustment for age, gender, ethnicity, chloride, sodium, Model for End-stage Liver Disease score, Sequential Organ Failure Assessment score, Elixhauser comorbidity index, mechanical ventilation, vasopressors, renal replacement therapy, acute kidney injury, hemoglobin, platelet, and white blood cell, serum chloride levels remained independently associated with ICU mortality (OR 0.94; 95% CI 0.91-0.98; p = 0.002) in contrast to serum sodium levels, which were no longer significant (OR 1.03; 95% CI 0.99-1.08; p = 0.119). The AUC of serum chloride levels (AUC, 0.600; 95% CI 0.556-0.643) for ICU mortality was statistically higher than that of serum sodium levels (AUC, 0.544; 95% CI 0.499-0.590) (p < 0.001).
conclusionsIn critically ill cirrhotic patients, serum chloride levels are independently and inversely associated with ICU mortality, thus highlighting the prognostic role of serum chloride levels which are largely overlooked.
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