Hospital-Acquired Serum Chloride Derangements and Associated In-Hospital Mortality

Thongprayoon, Charat; Cheungpasitporn, Wisit; Petnak, Tananchai; Mao, Michael A.; Chewcharat, Api; Qureshi, Fawad; Medaura, Juan; Bathini, Tarun; Vallabhajosyula, Saraschandra; Kashani, Kianoush B.

doi:10.3390/medicines7070038

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Hospital-Acquired Serum Chloride Derangements and Associated In-Hospital Mortality

Charat Thongprayoon

^1,*,

Wisit Cheungpasitporn

^2,*

^3,4,

⁵

¹,

²,

⁶,

Saraschandra Vallabhajosyula

⁷

and

Kianoush B. Kashani

^1,4

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA

Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA

Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand

⁴

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA

⁵

Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA

⁶

Department of Internal Medicine, University of Arizona, Tucson, AZ 85719, USA

⁷

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA

Authors to whom correspondence should be addressed.

Medicines 2020, 7(7), 38; https://doi.org/10.3390/medicines7070038

Received: 5 June 2020 / Revised: 27 June 2020 / Accepted: 28 June 2020 / Published: 29 June 2020

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Abstract

Background: We aimed to describe the incidence of hospital-acquired dyschloremia and its association with in-hospital mortality in general hospitalized patients. Methods: All hospitalized patients from 2009 to 2013 who had normal admission serum chloride and at least two serum chloride measurements in the hospital were studied. The normal range of serum chloride was defined as 100–108 mmol/L. Hospital serum chloride levels were grouped based on the occurrence of hospital-acquired hypochloremia and hyperchloremia. The association of hospital-acquired hypochloremia and hyperchloremia with in-hospital mortality was analyzed using logistic regression. Results: Among the total of 39,298 hospitalized patients, 59% had persistently normal hospital serum chloride levels, 21% had hospital-acquired hypochloremia only, 15% had hospital-acquired hyperchloremia only, and 5% had both hypochloremia and hyperchloremia. Compared with patients with persistently normal hospital serum chloride levels, hospital-acquired hyperchloremia only (odds ratio or OR 2.84; p < 0.001) and both hospital-acquired hypochloremia and hyperchloremia (OR 1.72; p = 0.004) were associated with increased in-hospital mortality, whereas hospital-acquired hypochloremia only was not (OR 0.91; p = 0.54). Conclusions: Approximately 40% of hospitalized patients developed serum chloride derangements. Hospital-acquired hyperchloremia, but not hypochloremia, was associated with increased in-hospital mortality. View Full-Text

Keywords: hyperchloremia; hypochloremia; chloride; electrolytes; internal medicine; mortality; nephrology; hospitalization

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MDPI and ACS Style

Thongprayoon, C.; Cheungpasitporn, W.; Petnak, T.; Mao, M.A.; Chewcharat, A.; Qureshi, F.; Medaura, J.; Bathini, T.; Vallabhajosyula, S.; Kashani, K.B. Hospital-Acquired Serum Chloride Derangements and Associated In-Hospital Mortality. Medicines 2020, 7, 38. https://doi.org/10.3390/medicines7070038

AMA Style

Thongprayoon C, Cheungpasitporn W, Petnak T, Mao MA, Chewcharat A, Qureshi F, Medaura J, Bathini T, Vallabhajosyula S, Kashani KB. Hospital-Acquired Serum Chloride Derangements and Associated In-Hospital Mortality. Medicines. 2020; 7(7):38. https://doi.org/10.3390/medicines7070038

Chicago/Turabian Style

Thongprayoon, Charat, Wisit Cheungpasitporn, Tananchai Petnak, Michael A. Mao, Api Chewcharat, Fawad Qureshi, Juan Medaura, Tarun Bathini, Saraschandra Vallabhajosyula, and Kianoush B. Kashani. 2020. "Hospital-Acquired Serum Chloride Derangements and Associated In-Hospital Mortality" Medicines 7, no. 7: 38. https://doi.org/10.3390/medicines7070038

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