ArticlePloS one2022
Association between serum chloride levels with mortality in critically ill patients with acute kidney injury: An observational multicenter study employing the eICU database.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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13 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Dysregulated serum chloride and clinical outcomes in critically ill adults: A systematic review and meta-analysis.PloS one · 2025Pooled it
- L-shaped association between serum chloride levels with 30-day and 365-day all-cause mortality in septic patients with liver cirrhosis.BMC infectious diseases · 2026Article
- Initial serum chloride is associated with all-cause mortality in critically ill patients with acute kidney injury.Renal failure · 2025Article
- Predicting In-Hospital Mortality in Intensive Care Unit Patients Using Causal SurvivalNet With Serum Chloride and Other Causal Factors: Cross-Country Study.Journal of medical Internet research · 2025Article
- Longitudinal serum chloride trajectories and their correlation with all-cause mortality in critically Ill sepsis patients: a retrospective cohort analysis.BMC infectious diseases · 2025Article
- Hypochloremia is an underutilised prognostic marker in patients with advanced liver cirrhosis and liver failure.World journal of hepatology · 2025Review
- Impact of Arginine Hydrochloride Supplementation on Diuretic Effectiveness in Critically Ill Children.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 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
- Observational
- Association between serum chloride levels and estimated glomerular filtration rate among US adults: evidence from NHANES 1999-2018.International urology and nephrology · 2024Article
- Association of Serum Blood Urea Nitrogen to Albumin Ratio with in-Hospital Mortality in Patients with Acute Ischemic Stroke: A Retrospective Cohort Study of the eICU DatabaseBalkan medical journal · 2024Article
- Dyschloremia and Renal Outcomes in Critically Ill Patients With Sepsis: A Prospective Cohort Study: Dyschloremia and Renal Outcomes in Sepsis.Critical care research and practice · 2024Article
- A clinically applicable prediction model for the risk of in-hospital mortality in solid cancer patients admitted to intensive care units with sepsis.Journal of cancer research and clinical oncology · 2023Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe effect of the serum chloride (Cl) level on mortality in critically ill patients with acute kidney injury (AKI) remains unknown. We sought an association between mortality and serum Cl.
methodsWe identified AKI patients in the eICU Collaborative Research Database from 2014 to 2015 at 208 US hospitals. The outcomes included in-hospital and intensive care unit (ICU) mortality. Time-varying covariates Cox regression models and the Kaplan-Meier (K-M) curves were used to assess the association between serum Cl levels and mortality. Multivariable adjusted restricted cubic spline models were used to analyze the potential nonlinear relationship between mortality and serum Cl.
resultsIn total, 4,234 AKI patients were included in the study. Compared with normochloremia (98≤chloride<108mEq/L), hypochloremia (Cl<98mEq/L) was associated with mortality (adjusted hazard ratio [HR] for in-hospital mortality 1.46, 95% confidence interval [CI] 1.20-1.80, P = 0.0003; adjusted HR for ICU mortality 1.37, 95% CI 1.05-1.80, P = 0.0187). Hyperchloremia showed no significant difference in mortality compared to normochloremia (adjusted HR for in-hospital mortality 0.89, 95% CI 0.76-1.04, P = 0.1438; adjusted HR for ICU mortality 0.87, 95% CI 0.72-1.06, P = 0.1712). Smoothing curves revealed continuous non-linear associations between serum Cl levels and mortality. The K-M curve showed that patients with hypochloremia presented with a lower survival rate.
conclusionsLower serum Cl levels after ICU admission was associated with increased in-hospital and ICU mortality in critically ill patients with AKI. The results should be verified in well-designed prospective studies.
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