ArticleBMC anesthesiology2025
Association between sodium-chloride difference at ICU admission and 30-day mortality: a retrospective cohort study of critically ill adults.
Article in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
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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.
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Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
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Authors and funding
28 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe difference between serum sodium and chloride concentrations (SCD) is a simple parameter reflecting the interplay between major extracellular electrolytes. We investigated whether SCD assessed upon intensive care unit (ICU) admission holds predictive value for short-term outcomes in critically ill adults.
methodsWe retrospectively analyzed 1,726 consecutive patients admitted to a mixed (medical-surgical) ICU (median age 67 years; 70.7% male). The relationship between admission SCD and 30-day mortality was first assessed using restricted cubic spline (RCS) regression to explore non-linearity. To define potential thresholds, cut-off values were evaluated using ROC analysis with the Youden index. Cox proportional hazards models were then applied. Internal validation was performed using bootstrap resampling with 1,000 iterations.
resultsRCS analysis revealed a non-linear association between SCD and mortality, with risk increasing markedly at lower values. Both spline modeling and receiver operating characteristic (ROC) analysis consistently indicated 30 mmol/L as the threshold of prognostic significance. Patients with SCD < 30 mmol/L (n = 343; 19.9%) had significantly higher 30-day mortality compared with those with SCD ≥ 30 mmol/L (55.7% vs. 44.3%, p < 0.001). In Cox regression, SCD < 30 mmol/L was associated with increased mortality (unadjusted HR 1.41, 95% CI 1.20-1.66; p < 0.001). This relationship remained robust after adjustment for age, SOFA score, lactate, and major comorbidities (adjusted HR 1.48, 95% CI 1.24-1.77; p < 0.001) and was confirmed by bootstrap validation.
conclusionsLow SCD at ICU admission was independently associated with higher 30-day mortality. This routinely available parameter, reflecting the sodium-chloride interplay, may support early risk stratification in this group of patients.
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