Risks/Mortality/OutcomesIs hyperchloremia associated with mortality in critically ill patients? A prospective cohort study
Introduction
Acid-base disorders are common in critically ill patients, and they are generally associated with greater morbidity and mortality [1]. Methods that allow understanding the nature of these disorders and consequently identifying treatments that can avoid and/or correct them are extremely important [2]. The Stewart approach [3], [4], modified by Figge [5], [6], has been applied to the analysis of such acid-base disorders, and some studies found a greater sensitivity compared to the traditional method [7], [8], [9], [10].
Markers of acidosis such as pH, standard base excess (SBE), and lactate are often used to predict which patients are likely to deteriorate [10], [11], [12]. Much uncertainty remains about the prognostic value of these traditional variables. With the Stewart approach, a greater prognostic value of the identification of unmeasured anions has been suggested [7], [9], [13], [14], and there has been renewed interest in hyperchloremic metabolic acidosis [15].
The objective of this study was to determine if acid-base variables are associated with hospital mortality. Some results of this study have previously been published [16].
Section snippets
Material and methods
This observational prospective study took place in a single intensive care unit (ICU) with 25 adult medical-surgical beds at a university hospital in Porto Alegre, Brazil. As previously described [16], all the patients admitted to the ICU during the period of February to May 2007 were included in the study. Patients were excluded if they did not have all the laboratory variables needed for the acid-base evaluation proposed and/or remained in the ICU for less than 24 hours.
The study was approved
Results
Two hundred twelve patients were included in the study. Thirty-seven of the patients were excluded because they did not have all the laboratory variables needed or because they stayed in the ICU less than 24 hours. Thus, 175 patients were included for final analysis. The demographic, clinical, and outcome variables are shown in Table 1.
The presence of unmeasured anions defined by elevated SIG (>2 mEq/L) was identified in 149 (85.1%) patients, whereas hyperlactatemia (lactate > 2 mmol/L) was
Discussion
The main result of this study is the greater contribution of chloride and albumin to predict hospital mortality in critically ill patients compared to the contribution of others acid-base variables.
Several studies found a significant association between SIG and mortality [7], [9], [13], [14], whereas others did not [8], [24], [25]. In our study, SIG was different between survivors and nonsurvivors but with a small AUROC and without contribution to the final model (Table 4). We did not control
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