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Susanne Muehlschlegel - One of the best experts on this subject based on the ideXlab platform.
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Hyperchloremia not concomitant hypernatremia independently predicts early mortality in critically ill moderate severe traumatic brain injury patients
Neurocritical Care, 2020Co-Authors: Kristen Ditch, Julie M Flahive, Ashley West, Marcy L Osgood, Susanne MuehlschlegelAbstract:Hypernatremia has been associated with mortality in neurocritically ill patients, with and without traumatic brain injury (TBI). These studies, however, lack concomitant adjustment for Hyperchloremia as a physiologically co-occurring finding despite the associations with Hyperchloremia and worse outcomes after trauma, sepsis, and intracerebral hemorrhage. The objective of our study was to examine the association of concomitant hypernatremia and Hyperchloremia with in-hospital mortality in moderate–severe TBI (msTBI) patients. We retrospectively analyzed prospectively collected data from the OPTIMISM-study and included all msTBI patients consecutively enrolled between 11/2009 and 1/2017. Time-weighted average (TWA) sodium and chloride values were calculated for all patients to examine the unadjusted mortality rates associated with the burden of hypernatremia and Hyperchloremia over the entire duration of the intensive care unit stay. Multivariable logistic regression modeling predicting in-hospital mortality adjusted for validated confounders of msTBI mortality was applied to evaluate the concomitant effects of hypernatremia and Hyperchloremia. Internal bootstrap validation was performed. Of the 458 patients included for analysis, 202 (44%) died during the index hospitalization. Fifty-five patients (12%) were excluded due to missing data. Unadjusted mortality rates were nearly linearly increasing for both TWA sodium and TWA chloride, and were highest for patients with a TWA sodium > 160 mmol/L (100% mortality) and TWA chloride > 125 mmol/L (94% mortality). When evaluated separately in the multivariable analysis, TWA sodium (per 10 mmol/L change: adjusted OR 4.0 [95% CI 2.1–7.5]) and TWA chloride (per 10 mmol/L change: adjusted OR 3.9 [95% CI 2.2–7.1]) independently predicted in-hospital mortality. When evaluated in combination, TWA chloride remained independently associated with in-hospital mortality (per 10 mmol/L change: adjusted OR 2.9 [95% CI 1.1–7.8]), while this association was no longer observed with TWA sodium values (per 10 mmol/L change: adjusted OR 1.5 [95% CI 0.51–4.4]). When concomitantly adjusting for the burden of Hyperchloremia and hypernatremia, only Hyperchloremia was independently associated with in-hospital mortality in our msTBI cohort. Pending validation, our findings may provide the rationale for future studies with targeted interventions to reduce Hyperchloremia and improve outcomes in msTBI patients.
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Hyperchloremia not concomitant hypernatremia independently predicts early mortality in critically ill moderate severe traumatic brain injury patients
Neurocritical Care, 2020Co-Authors: Kristen Ditch, Julie M Flahive, Ashley West, Marcy L Osgood, Susanne MuehlschlegelAbstract:BACKGROUND Hypernatremia has been associated with mortality in neurocritically ill patients, with and without traumatic brain injury (TBI). These studies, however, lack concomitant adjustment for Hyperchloremia as a physiologically co-occurring finding despite the associations with Hyperchloremia and worse outcomes after trauma, sepsis, and intracerebral hemorrhage. The objective of our study was to examine the association of concomitant hypernatremia and Hyperchloremia with in-hospital mortality in moderate-severe TBI (msTBI) patients. METHODS We retrospectively analyzed prospectively collected data from the OPTIMISM-study and included all msTBI patients consecutively enrolled between 11/2009 and 1/2017. Time-weighted average (TWA) sodium and chloride values were calculated for all patients to examine the unadjusted mortality rates associated with the burden of hypernatremia and Hyperchloremia over the entire duration of the intensive care unit stay. Multivariable logistic regression modeling predicting in-hospital mortality adjusted for validated confounders of msTBI mortality was applied to evaluate the concomitant effects of hypernatremia and Hyperchloremia. Internal bootstrap validation was performed. RESULTS Of the 458 patients included for analysis, 202 (44%) died during the index hospitalization. Fifty-five patients (12%) were excluded due to missing data. Unadjusted mortality rates were nearly linearly increasing for both TWA sodium and TWA chloride, and were highest for patients with a TWA sodium > 160 mmol/L (100% mortality) and TWA chloride > 125 mmol/L (94% mortality). When evaluated separately in the multivariable analysis, TWA sodium (per 10 mmol/L change: adjusted OR 4.0 [95% CI 2.1-7.5]) and TWA chloride (per 10 mmol/L change: adjusted OR 3.9 [95% CI 2.2-7.1]) independently predicted in-hospital mortality. When evaluated in combination, TWA chloride remained independently associated with in-hospital mortality (per 10 mmol/L change: adjusted OR 2.9 [95% CI 1.1-7.8]), while this association was no longer observed with TWA sodium values (per 10 mmol/L change: adjusted OR 1.5 [95% CI 0.51-4.4]). CONCLUSIONS When concomitantly adjusting for the burden of Hyperchloremia and hypernatremia, only Hyperchloremia was independently associated with in-hospital mortality in our msTBI cohort. Pending validation, our findings may provide the rationale for future studies with targeted interventions to reduce Hyperchloremia and improve outcomes in msTBI patients.
Danielle Davison - One of the best experts on this subject based on the ideXlab platform.
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association of Hyperchloremia and acute kidney injury in patients with traumatic brain injury
Journal of Intensive Care Medicine, 2020Co-Authors: David Yamane, Sam Maghami, Ada Graham, Khashayar Vaziri, Danielle DavisonAbstract:Introduction:Hypertonic saline is often used to treat patients with traumatic brain injury. It carries the undesired side effect of Hyperchloremia, which has been linked to acute kidney injury (AKI...
Kristen Ditch - One of the best experts on this subject based on the ideXlab platform.
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Hyperchloremia not concomitant hypernatremia independently predicts early mortality in critically ill moderate severe traumatic brain injury patients
Neurocritical Care, 2020Co-Authors: Kristen Ditch, Julie M Flahive, Ashley West, Marcy L Osgood, Susanne MuehlschlegelAbstract:Hypernatremia has been associated with mortality in neurocritically ill patients, with and without traumatic brain injury (TBI). These studies, however, lack concomitant adjustment for Hyperchloremia as a physiologically co-occurring finding despite the associations with Hyperchloremia and worse outcomes after trauma, sepsis, and intracerebral hemorrhage. The objective of our study was to examine the association of concomitant hypernatremia and Hyperchloremia with in-hospital mortality in moderate–severe TBI (msTBI) patients. We retrospectively analyzed prospectively collected data from the OPTIMISM-study and included all msTBI patients consecutively enrolled between 11/2009 and 1/2017. Time-weighted average (TWA) sodium and chloride values were calculated for all patients to examine the unadjusted mortality rates associated with the burden of hypernatremia and Hyperchloremia over the entire duration of the intensive care unit stay. Multivariable logistic regression modeling predicting in-hospital mortality adjusted for validated confounders of msTBI mortality was applied to evaluate the concomitant effects of hypernatremia and Hyperchloremia. Internal bootstrap validation was performed. Of the 458 patients included for analysis, 202 (44%) died during the index hospitalization. Fifty-five patients (12%) were excluded due to missing data. Unadjusted mortality rates were nearly linearly increasing for both TWA sodium and TWA chloride, and were highest for patients with a TWA sodium > 160 mmol/L (100% mortality) and TWA chloride > 125 mmol/L (94% mortality). When evaluated separately in the multivariable analysis, TWA sodium (per 10 mmol/L change: adjusted OR 4.0 [95% CI 2.1–7.5]) and TWA chloride (per 10 mmol/L change: adjusted OR 3.9 [95% CI 2.2–7.1]) independently predicted in-hospital mortality. When evaluated in combination, TWA chloride remained independently associated with in-hospital mortality (per 10 mmol/L change: adjusted OR 2.9 [95% CI 1.1–7.8]), while this association was no longer observed with TWA sodium values (per 10 mmol/L change: adjusted OR 1.5 [95% CI 0.51–4.4]). When concomitantly adjusting for the burden of Hyperchloremia and hypernatremia, only Hyperchloremia was independently associated with in-hospital mortality in our msTBI cohort. Pending validation, our findings may provide the rationale for future studies with targeted interventions to reduce Hyperchloremia and improve outcomes in msTBI patients.
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Hyperchloremia not concomitant hypernatremia independently predicts early mortality in critically ill moderate severe traumatic brain injury patients
Neurocritical Care, 2020Co-Authors: Kristen Ditch, Julie M Flahive, Ashley West, Marcy L Osgood, Susanne MuehlschlegelAbstract:BACKGROUND Hypernatremia has been associated with mortality in neurocritically ill patients, with and without traumatic brain injury (TBI). These studies, however, lack concomitant adjustment for Hyperchloremia as a physiologically co-occurring finding despite the associations with Hyperchloremia and worse outcomes after trauma, sepsis, and intracerebral hemorrhage. The objective of our study was to examine the association of concomitant hypernatremia and Hyperchloremia with in-hospital mortality in moderate-severe TBI (msTBI) patients. METHODS We retrospectively analyzed prospectively collected data from the OPTIMISM-study and included all msTBI patients consecutively enrolled between 11/2009 and 1/2017. Time-weighted average (TWA) sodium and chloride values were calculated for all patients to examine the unadjusted mortality rates associated with the burden of hypernatremia and Hyperchloremia over the entire duration of the intensive care unit stay. Multivariable logistic regression modeling predicting in-hospital mortality adjusted for validated confounders of msTBI mortality was applied to evaluate the concomitant effects of hypernatremia and Hyperchloremia. Internal bootstrap validation was performed. RESULTS Of the 458 patients included for analysis, 202 (44%) died during the index hospitalization. Fifty-five patients (12%) were excluded due to missing data. Unadjusted mortality rates were nearly linearly increasing for both TWA sodium and TWA chloride, and were highest for patients with a TWA sodium > 160 mmol/L (100% mortality) and TWA chloride > 125 mmol/L (94% mortality). When evaluated separately in the multivariable analysis, TWA sodium (per 10 mmol/L change: adjusted OR 4.0 [95% CI 2.1-7.5]) and TWA chloride (per 10 mmol/L change: adjusted OR 3.9 [95% CI 2.2-7.1]) independently predicted in-hospital mortality. When evaluated in combination, TWA chloride remained independently associated with in-hospital mortality (per 10 mmol/L change: adjusted OR 2.9 [95% CI 1.1-7.8]), while this association was no longer observed with TWA sodium values (per 10 mmol/L change: adjusted OR 1.5 [95% CI 0.51-4.4]). CONCLUSIONS When concomitantly adjusting for the burden of Hyperchloremia and hypernatremia, only Hyperchloremia was independently associated with in-hospital mortality in our msTBI cohort. Pending validation, our findings may provide the rationale for future studies with targeted interventions to reduce Hyperchloremia and improve outcomes in msTBI patients.
Young Tae Jeon - One of the best experts on this subject based on the ideXlab platform.
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perioperative Hyperchloremia and its association with postoperative acute kidney injury after craniotomy for primary brain tumor resection a retrospective observational study
Journal of Neurosurgical Anesthesiology, 2019Co-Authors: Chae Yong Kim, Young Tae Jeon, Jungwon HwangAbstract:Background Hyperchloremia is known to influence postoperative outcomes and may result in postoperative acute kidney injury (AKI). This study sought to investigate whether Hyperchloremia was associated with postoperative AKI in patients who underwent surgery for primary brain tumor resection. Materials and methods This is a retrospective, observational study of patients who underwent craniotomy for primary brain tumor resection at a single tertiary care hospital between January 2005 and October 2017. Maximum levels of serum chloride (mmol/L) measured on postoperative days (PODs) 0 to 3 and increase in serum chloride (mmol/L), (maximum serum chloride-baseline serum chloride before surgery) were measured. We examined whether perioperative Hyperchloremia was associated with postoperative AKI during PODs 0 to 3. Univariate and multivariate logistic regression analyses were used in this study. Results A total of 726 patients were included in the analysis; of these, 39 (5.4%) were diagnosed with postoperative AKI during PODs 0 to 3. The risk of postoperative AKI was associated with maximum chloride levels (odds ratio, 1.10; 95% confidence interval, 1.02-1.19; P=0.015) and with an increase in serum chloride levels during PODs 0 to 3 (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; P=0.004). Conclusions Our study shows that perioperative Hyperchloremia during PODs 0 to 3 was associated with an increased risk of postoperative AKI during this period after craniotomy for primary brain tumor resection.
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association of perioperative Hyperchloremia and hyperchloremic metabolic acidosis with acute kidney injury after craniotomy for intracranial hemorrhage
World Neurosurgery, 2019Co-Authors: Young Tae Jeon, Hyemin Sohn, Seung Hyun ChungAbstract:Background The present study evaluated the relationships among perioperative hyperchloremic metabolic acidosis (HCA), Hyperchloremia, and postoperative acute kidney injury (AKI) in patients who had undergone craniotomy for intracranial hemorrhage (ICH). Methods The present retrospective cohort study included adult patients who had undergone craniotomy for traumatic or spontaneous ICH from January 2005 to December 2017. The association of perioperative Hyperchloremia (serum chloride [Cl−] >110 mmol/L during postoperative days 0–3), an increase in Cl− levels (maximum Cl− level in postoperative days 0–3 minus the baseline Cl− level before surgery), and perioperative HCA (Cl− >110 mmol/L; pH Results A total of 968 patients were included. Of these patients, 117 (12.1%) had postoperative AKI. The multivariable logistic regression analysis showed that the development of HCA was associated with a 1.850-fold increase in the incidence of postoperative AKI (odds ratio [OR], 1.850; 95% confidence interval [CI], 1.102–3.106; P = 0.020). However, Hyperchloremia was not significantly related to the incidence of postoperative AKI (P = 0.207). Additionally, the presence of Hyperchloremia and an increase in Cl− levels were both associated with an increased incidence of HCA (Hyperchloremia group: OR, 2.162; 95% CI, 1.490–3.138; P Conclusions Perioperative HCA was independently related to an increased incidence of AKI after craniotomy for ICH. An increase in Cl− levels and perioperative Hyperchloremia were associated with increased development of HCA but were not significantly related to the development of postoperative AKI.
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Hyperchloremia and postoperative acute kidney injury a retrospective analysis of data from the surgical intensive care unit
Critical Care, 2018Co-Authors: In Ae Song, Sejoong Kim, Sung Yoon Lim, Jungwon Hwang, Jin Hee Kim, Young Tae JeonAbstract:Whether perioperative Hyperchloremia can induce postoperative acute kidney injury (AKI) is controversial. We investigated the association between perioperative Hyperchloremia and postoperative AKI in patients admitted to the intensive care unit (ICU) after surgery. We performed a retrospective observational study of patients admitted to the surgical ICU at a single tertiary care hospital between January 2011 and June 2016. Our primary objective was to determine whether Hyperchloremia or an increase in serum chloride levels was associated with postoperative AKI. Perioperative Hyperchloremia was defined as serum chloride levels ≥ 110 mmol·L− 1 during postoperative days (PODs) 0–3. The increase in serum chloride levels was defined as the difference between preoperative and maximum postoperative serum chloride levels during the first 3 days after surgery. Of the 7991 patients included in the final analysis, 1876 (23.5%) developed Hyperchloremia during PODs 0–3, and 1187 (14.9%) developed postoperative AKI. Exposure to Hyperchloremia during the first 3 days after surgery was not associated with postoperative AKI (odds ratio, 1.09; 95% confidence interval, 0.80–1.49; P = 0.571). However, among patients with preoperative chronic kidney disease stage ≥ 3 (estimated glomerular filtration rate 6 mmol·L− 1 in serum chloride levels than in patients with an increase ≤ 1 mmol·L− 1 (odds ratio, 1.42; 95% confidence interval, 1.09–1.84; P = 0.009). In addition, the incidence of postoperative AKI stage ≥ 2 was not associated with exposure to Hyperchloremia or with the increase in serum chloride levels during PODs 0–3, regardless of preoperative kidney function. Exposure to perioperative Hyperchloremia is not associated with postoperative AKI in surgical ICU patients. However, in patients with moderate-to-severe chronic kidney disease (stage ≥ 3), a substantial perioperative increase in serum chloride levels may reflect a higher risk of AKI.
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Hyperchloremia and postoperative acute kidney injury: a retrospective analysis of data from the surgical intensive care unit
'Springer Science and Business Media LLC', 2018Co-Authors: In Ae Song, Sejoong Kim, Sung Yoon Lim, Jungwon Hwang, Jin Hee Kim, Young Tae JeonAbstract:Abstract Background Whether perioperative Hyperchloremia can induce postoperative acute kidney injury (AKI) is controversial. We investigated the association between perioperative Hyperchloremia and postoperative AKI in patients admitted to the intensive care unit (ICU) after surgery. Methods We performed a retrospective observational study of patients admitted to the surgical ICU at a single tertiary care hospital between January 2011 and June 2016. Our primary objective was to determine whether Hyperchloremia or an increase in serum chloride levels was associated with postoperative AKI. Perioperative Hyperchloremia was defined as serum chloride levels ≥ 110 mmol·L− 1 during postoperative days (PODs) 0–3. The increase in serum chloride levels was defined as the difference between preoperative and maximum postoperative serum chloride levels during the first 3 days after surgery. Results Of the 7991 patients included in the final analysis, 1876 (23.5%) developed Hyperchloremia during PODs 0–3, and 1187 (14.9%) developed postoperative AKI. Exposure to Hyperchloremia during the first 3 days after surgery was not associated with postoperative AKI (odds ratio, 1.09; 95% confidence interval, 0.80–1.49; P = 0.571). However, among patients with preoperative chronic kidney disease stage ≥ 3 (estimated glomerular filtration rate 6 mmol·L− 1 in serum chloride levels than in patients with an increase ≤ 1 mmol·L− 1 (odds ratio, 1.42; 95% confidence interval, 1.09–1.84; P = 0.009). In addition, the incidence of postoperative AKI stage ≥ 2 was not associated with exposure to Hyperchloremia or with the increase in serum chloride levels during PODs 0–3, regardless of preoperative kidney function. Conclusions Exposure to perioperative Hyperchloremia is not associated with postoperative AKI in surgical ICU patients. However, in patients with moderate-to-severe chronic kidney disease (stage ≥ 3), a substantial perioperative increase in serum chloride levels may reflect a higher risk of AKI
Bandarn Suetrong - One of the best experts on this subject based on the ideXlab platform.
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Hyperchloremia and moderate increase in serum chloride are associated with acute kidney injury in severe sepsis and septic shock patients
Critical Care, 2016Co-Authors: Bandarn Suetrong, Chawika Pisitsak, John H Boyd, James A Russell, Keith R WalleyAbstract:Acute kidney injury and Hyperchloremia are commonly present in critically ill septic patients. Our study goal was to evaluate the association of Hyperchloremia and acute kidney injury in severe sepsis and septic shock patients. In this retrospective cohort study in a provincial tertiary care hospital, adult patients with severe sepsis or septic shock and serum chloride measurements were included. Serum chloride was measured on a daily basis for 48 hours. Primary outcome was development of acute kidney injury (AKI) and association of AKI and serum chloride parameters was analyzed. A total of 240 patients were included in the study, 98 patients (40.8 %) had Hyperchloremia. The incidence of acute kidney injury (AKI) was significantly higher in the Hyperchloremia group (85.7 % vs 47.9 %; p < 0.001). Maximal chloride concentration in the first 48 hours ([Cl-]max) was significantly associated with AKI. In multivariate analysis, [Cl-]max was independently associated with AKI [adjusted odds ratio (OR) for AKI = 1.28 (1.02–1.62); p = 0.037]. The increase in serum chloride (Δ[Cl-] = [Cl-]max – initial chloride concentration) demonstrated a dose-dependent relationship with severity of AKI. The mean Δ[Cl-] in patients without AKI was 2.1 mmol/L while in the patients with AKI stage 1, 2 and 3 the mean Δ[Cl-] was 5.1, 5.9 and 6.7 mmol/L, respectively. A moderate increase in serum chloride (Δ[Cl-] ≥ 5 mmol/L) was associated with AKI [OR = 5.70 (3.00–10.82); p < 0.001], even in patients without Hyperchloremia [OR = 8.25 (3.44–19.78); p < 0.001]. Hyperchloremia is common in severe sepsis and septic shock and independently associated with AKI. A moderate increase in serum chloride (Δ[Cl-] ≥5 mmol/L) is associated with AKI even in patients without Hyperchloremia.