Serum Chloride Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients

This study aimed to assess the one-year mortality risk based on discharge serum chloride among the hospital survivors. We analyzed a cohort of adult hospital survivors at a tertiary referral hospital from 2011 through 2013. We categorized discharge serum chloride; ≤96, 97–99, 100–102, 103–105, 106–108, and ≥109 mmoL/L. We performed Cox proportional hazard analysis to assess the association of discharge serum chloride with one-year mortality after hospital discharge, using discharge serum chloride of 103–105 mmoL/L as the reference group. Of 56,907 eligible patients, 9%, 14%, 26%, 28%, 16%, and 7% of patients had discharge serum chloride of ≤96, 97–99, 100–102, 103–105, 106–108, and ≥109 mmoL/L, respectively. We observed a U-shaped association of discharge serum chloride with one-year mortality, with nadir mortality associated with discharge serum chloride of 103–105 mmoL/L. When adjusting for potential confounders, including discharge serum sodium, discharge serum bicarbonate, and admission serum chloride, one-year mortality was significantly higher in both discharge serum chloride ≤99 hazard ratio (HR): 1.45 and 1.94 for discharge serum chloride of 97–99 and ≤96 mmoL/L, respectively; p < 0.001) and ≥109 mmoL/L (HR: 1.41; p < 0.001), compared with discharge serum chloride of 103–105 mmoL/L. The mortality risk did not differ when discharge serum chloride ranged from 100 to 108 mmoL/L. Of note, there was a significant interaction between admission and discharge serum chloride on one-year mortality. Serum chloride at hospital discharge in the optimal range of 100–108 mmoL/L predicted the favorable survival outcome. Both hypochloremia and hyperchloremia at discharge were associated with increased risk of one-year mortality, independent of admission serum chloride, discharge serum sodium, and serum bicarbonate.

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Serum Potassium Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients

Medicina ◽

10.3390/medicina56050236 ◽

2020 ◽

Vol 56 (5) ◽

pp. 236 ◽

Cited By ~ 2

Author(s):

Charat Thongprayoon ◽

Wisit Cheungpasitporn ◽

Sorkko Thirunavukkarasu ◽

Tananchai Petnak ◽

Api Chewcharat ◽

...

Keyword(s):

Hospital Discharge ◽

Serum Potassium ◽

Proportional Hazards ◽

Reference Group ◽

Cox Proportional Hazards ◽

Hospitalized Patients ◽

Tertiary Referral Hospital ◽

Increased Risk ◽

One Year ◽

End Stage

Background and Objectives: The optimal range of serum potassium at hospital discharge is unclear. The aim of this study was to assess the relationship between discharge serum potassium levels and one-year mortality in hospitalized patients. Materials and Methods: All adult hospital survivors between 2011 and 2013 at a tertiary referral hospital, who had available admission and discharge serum potassium data, were enrolled. End-stage kidney disease patients were excluded. Discharge serum potassium was defined as the last serum potassium level measured within 48 h prior to hospital discharge and categorized into ≤2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, 4.5–4.9, 5.0–5.4 and ≥5.5 mEq/L. A Cox proportional hazards analysis was performed to assess the independent association between discharge serum potassium and one-year mortality after hospital discharge, using the discharge potassium range of 4.0–4.4 mEq/L as the reference group. Results: Of 57,874 eligible patients, with a mean discharge serum potassium of 4.1 ± 0.4 mEq/L, the estimated one-year mortality rate after discharge was 13.2%. A U-shaped association was observed between discharge serum potassium and one-year mortality, with the nadir mortality in the discharge serum potassium range of 4.0–4.4 mEq/L. After adjusting for clinical characteristics, including admission serum potassium, both discharge serum potassium ≤3.9 mEq/L and ≥4.5 mEq/L were significantly associated with increased one-year mortality, compared with the discharge serum potassium of 4.0–4.4 mEq/L. Stratified analysis based on admission serum potassium showed similar results, except that there was no increased risk of one-year mortality when discharge serum potassium was ≤3.9 mEq/L in patients with an admission serum potassium of ≥5.0 mEq/L. Conclusion: The association between discharge serum potassium and one-year mortality after hospital discharge had a U-shaped distribution and was independent of admission serum potassium. Favorable survival outcomes occurred when discharge serum potassium was strictly within the range of 4.0–4.4 mEq/L.

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Admission Serum Potassium Levels in Hospitalized Patients and One-Year Mortality

Medicines ◽

10.3390/medicines7010002 ◽

2019 ◽

Vol 7 (1) ◽

pp. 2 ◽

Cited By ~ 5

Author(s):

Charat Thongprayoon ◽

Wisit Cheungpasitporn ◽

Panupong Hansrivijit ◽

Michael A. Mao ◽

Juan Medaura ◽

...

Keyword(s):

Kidney Disease ◽

Hospital Admission ◽

Serum Potassium ◽

Potassium Level ◽

Reference Group ◽

Kidney Injury ◽

Hospitalized Patients ◽

Tertiary Referral Hospital ◽

Increased Risk ◽

One Year

Background: The aim of this study was to assess the relationship between admission serum potassium and one-year mortality in all adult hospitalized patients. Methods: All adult hospitalized patients who had an admission serum potassium level between the years 2011 and 2013 at a tertiary referral hospital were enrolled. End-stage kidney disease patients were excluded. Admission serum potassium was categorized into levels of ≤2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, 4.5–4.9, 5.0–5.4, and ≥5.5 mEq/L. Cox proportional hazard analysis was performed to assess the independent association between admission serum potassium and one-year mortality after hospital admission, using an admission potassium level of 4.0–4.4 mEq/L as the reference group. Results: A total of 73,983 patients with mean admission potassium of 4.2 ± 0.5 mEq/L were studied. Of these, 12.6% died within a year after hospital admission, with the lowest one-year mortality associated with an admission serum potassium of 4.0–4.4 mEq/L. After adjustment for age, sex, race, estimated glomerular filtration rate (eGFR), principal diagnosis, comorbidities, medications, acute kidney injury, mechanical ventilation, and other electrolytes at hospital admission, both a low admission serum potassium ≤3.9 mEq/L and elevated admission potassium ≥5.0 mEq/L were significantly associated with an increased risk of one-year mortality, when compared with an admission serum potassium of 4.0–4.4 mEq/L. Subgroup analysis of chronic kidney disease and cardiovascular disease patients showed similar results. Conclusion: This study demonstrated that hypokalemia ≤3.9 mEq/L and hyperkalemia ≥5.0 mEq/L at the time of hospital admission were associated with higher one-year mortality.

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Trajectories of Serum Sodium on In-Hospital and 1-Year Survival among Hospitalized Patients

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.12281019 ◽

2020 ◽

Vol 15 (5) ◽

pp. 600-607 ◽

Cited By ~ 4

Author(s):

Api Chewcharat ◽

Charat Thongprayoon ◽

Wisit Cheungpasitporn ◽

Michael A. Mao ◽

Sorkko Thirunavukkarasu ◽

...

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Mortality Risk ◽

Serum Sodium ◽

Odds Ratio ◽

Reference Group ◽

High Serum ◽

Single Center ◽

Outcome Comparison ◽

One Year

Background and objectivesThis study aimed to investigate the association between in-hospital trajectories of serum sodium and risk of in-hospital and 1-year mortality in patients in hospital.Design, setting, participants, & measurementsThis is a single-center cohort study. All adult patients who were hospitalized from years 2011 through 2013 who had available admission serum sodium and at least three serum sodium measurements during hospitalization were included. The trend of serum sodium during hospitalization was analyzed using group-based trajectory modeling; the five main trajectories were grouped as follows: (1) stable normonatremia, (2) uncorrected hyponatremia, (3) borderline high serum sodium, (4) corrected hyponatremia, and (5) fluctuating serum sodium. The outcome of interest was in-hospital mortality and 1-year mortality. Stable normonatremia was used as the reference group for outcome comparison.ResultsA total of 43,539 patients were analyzed. Of these, 47% had stable normonatremia, 15% had uncorrected hyponatremia, 31% had borderline high serum sodium, 3% had corrected hyponatremia, and 5% had fluctuating serum sodium trajectory. In adjusted analysis, there was a higher in-hospital mortality among those with uncorrected hyponatremia (odds ratio [OR], 1.33; 95% CI, 1.06 to 1.67), borderline high serum sodium (OR, 1.66; 95% CI, 1.38 to 2.00), corrected hyponatremia (OR, 1.50; 95% CI, 1.02 to 2.20), and fluctuating serum sodium (OR, 4.61; 95% CI, 3.61 to 5.88), compared with those with the normonatremia trajectory. One-year mortality was higher among those with uncorrected hyponatremia (hazard ratio [HR], 1.28; 95% CI, 1.19 to 1.38), borderline high serum sodium (HR, 1.18; 95% CI, 1.11 to 1.26), corrected hyponatremia (HR, 1.24; 95% CI, 1.08 to 1.42), and fluctuating serum sodium (HR, 2.10; 95% CI, 1.89 to 2.33) compared with those with the normonatremia trajectory.ConclusionsMore than half of patients who had been hospitalized had an abnormal serum sodium trajectory during hospitalization. This study demonstrated that not only the absolute serum sodium levels but also their in-hospital trajectories were significantly associated with in-hospital and 1-year mortality. The highest in-hospital and 1-year mortality risk was associated with the fluctuating serum sodium trajectory.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_25_CJN.12281019.mp3

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Lower serum chloride concentrations are associated with increased risk of mortality in critically ill cirrhotic patients: an analysis of the MIMIC-III database

BMC Gastroenterology ◽

10.1186/s12876-021-01797-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yun Ji ◽

Libin Li

Keyword(s):

Critically Ill ◽

Serum Sodium ◽

Kidney Injury ◽

Icu Mortality ◽

Independent Prognostic Marker ◽

Risk Of Mortality ◽

Serum Chloride ◽

Increased Risk ◽

Cirrhotic Patients ◽

End Stage

Abstract Background Cirrhosis can be complicated by electrolyte abnormalities, but the major focus has been concentrated on the clinical significance of serum sodium levels. Emerging studies have identified hypochloremia as an independent prognostic marker in patients with chronic heart failure and chronic kidney disease. The aim of this study was to investigate whether serum chloride levels were associated with mortality of critically ill cirrhotic patients. Methods Critically ill cirrhotic patients were identified from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. The primary outcome was ICU mortality. Logistic regression was used to explore the association between serum chloride levels and ICU mortality. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of serum chloride levels for predicting ICU mortality. Results A total of 1216 critically ill cirrhotic patients were enrolled in this study. The overall ICU mortality rate was 18.8%. Patients with hypochloremia had a higher ICU mortality than those with non-hypochloremia (34.2% vs. 15.8%; p < 0.001). After multivariable risk adjustment for age, gender, ethnicity, chloride, sodium, Model for End-stage Liver Disease score, Sequential Organ Failure Assessment score, Elixhauser comorbidity index, mechanical ventilation, vasopressors, renal replacement therapy, acute kidney injury, hemoglobin, platelet, and white blood cell, serum chloride levels remained independently associated with ICU mortality (OR 0.94; 95% CI 0.91–0.98; p = 0.002) in contrast to serum sodium levels, which were no longer significant (OR 1.03; 95% CI 0.99–1.08; p = 0.119). The AUC of serum chloride levels (AUC, 0.600; 95% CI 0.556–0.643) for ICU mortality was statistically higher than that of serum sodium levels (AUC, 0.544; 95% CI 0.499–0.590) (p < 0.001). Conclusions In critically ill cirrhotic patients, serum chloride levels are independently and inversely associated with ICU mortality, thus highlighting the prognostic role of serum chloride levels which are largely overlooked.

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An analysis of the impact of fluid overload and fluid depletion for all-cause and cardiovascular mortality

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy396 ◽

2019 ◽

Vol 34 (8) ◽

pp. 1385-1393 ◽

Cited By ~ 3

Author(s):

Dimitrie Siriopol ◽

Mihaela Siriopol ◽

Stefano Stuard ◽

Luminita Voroneanu ◽

Peter Wabel ◽

...

Keyword(s):

Mortality Risk ◽

Fluid Overload ◽

Reference Group ◽

Volume Status ◽

Time Varying ◽

Dialysis Fluid ◽

Fluid Status ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Both baseline fluid overload (FO) and fluid depletion are associated with increased mortality risk and cardiovascular complications in haemodialysis patients. Fluid status may vary substantially over time, and this variability could also be associated with poor outcomes. Methods In our retrospective cohort study, including 4114 haemodialysis patients from 34 Romanian dialysis units, we investigated both all-cause and cardiovascular mortality risk according to baseline pre- and post-dialysis volume status, changes in pre- and post-dialysis fluid status during follow-up (time-varying survival analysis), pre–post changes in volume status during dialysis and pre-dialysis fluid status variability during the first 6 months of evaluation. Results According to their pre-dialysis fluid status, patients were stratified in the following groups: normovolaemic with an absolute FO (AFO) compartment between −1.1 and 1.1 L, fluid depletion with an AFO below −1.1 L, moderate FO with an AFO compartment >1.1 but <2.5 L and severe FO with the AFO compartment >2.5 L. Baseline pre-dialysis FO and fluid depletion patients had a significantly elevated risk of all-cause mortality risk {hazard ratio [HR] 1.53 [95% confidence interval (CI) 1.22–1.93], HR 2.04 (95% CI 1.59–2.60) and HR 1.88 (95% CI 1.07–3.39) for moderate FO, severe FO and fluid depletion, respectively}. In contrast, post-dialysis fluid depletion was associated with better survival [HR 0.71 (95% CI 0.57–0.89)]. Similar results were found when using changes in pre- or post-dialysis fluid status during follow-up (time-varying values): FO patients had an increased risk of all-cause [moderate FO: HR 1.39 (95% CI 1.11–1.75); severe FO: HR 2.29 (95% CI 2.01–3.31] and cardiovascular (CV) mortality [moderate FO: HR 1.34 (95% CI 1.05–1.70); severe FO: HR 2.34 (95% CI 1.67–3.28)] as compared with normohydrated patients. Using pre–post changes in volume status during dialysis, we categorized the patients into six groups: Group 1, AFO <−1.1 L pre- and post-dialysis; Group 2, AFO between −1.1 and 1.1 L pre-dialysis and <−1.1 L post-dialysis (the reference group); Group 3, AFO between −1.1 and 1.1 L pre- and post-dialysis; Group 4, AFO >1.1 L pre-dialysis and <−1.1 L post-dialysis; Group 5, AFO >1.1 L pre-dialysis and between −1.1 and 1.1 L post-dialysis; Group 6, AFO >1.1 L pre- and post-dialysis. Using the baseline values, only patients in Groups 1, 5 and 6 maintained an increased risk for all-cause mortality as compared with the reference group. Additionally, CV mortality risk was significantly higher for patients in Groups 5 and 6. When we applied the time-varying analysis, patients in Groups 1, 5 and 6 had a significantly higher risk for both all-cause and CV mortality risk. In the last approach, the highest risk for the all-cause mortality outcome was observed for patients with high-amplitude fluctuation during the first 6 months of evaluation [HR 2.75 (95% CI 1.29–5.84)]. Conclusion We reconfirm the association between baseline pre- and post-dialysis volume status and mortality in dialysis patients; additionally, we showed that greater fluid status variability is independently associated with higher mortality.

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Short-term prognosis of normalising serum potassium following an episode of hypokalaemia in patients with chronic heart failure

European Journal of Preventive Cardiology ◽

10.1177/2047487320911154 ◽

2020 ◽

pp. 204748732091115

Author(s):

Mette Aldahl ◽

Christoffer Polcwiartek ◽

Line Davidsen ◽

Kristian Kragholm ◽

Peter Søgaard ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Confidence Interval ◽

Mortality Risk ◽

Cardiovascular Mortality ◽

Serum Potassium ◽

Reference Group ◽

Hazard Ratio ◽

Increased Risk ◽

All Cause Mortality

Background/aim It is well known that patients with chronic heart failure and hypokalaemia have increased mortality risk. We investigated the impact of normalising serum potassium following an episode of hypokalaemia on short-term mortality among patients with chronic heart failure. Methods and results We identified 1673 patients diagnosed with chronic heart failure who had a serum potassium measurement under 3.5 mmol/l within 14 days and one year after initiated medical treatment with both loop diuretics and angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers. A second serum potassium measurement was required 8–30 days after the episode of hypokalaemia. All-cause mortality and cardiovascular mortality was examined within 90 days from the second serum potassium measurement. Mortality was examined according to six predefined potassium groups derived from the second measurement:<3.5 mmol/l ( n = 302), 3.5–3.7 mmol/l ( n = 271), 3.8–4.1 mmol/l ( n = 464), 4.2–4.4 mmol/l ( n = 270), 4.5–5.0 mmol/l ( n = 272), and 5.1–8.0 mmol/l ( n = 94). We used Cox regression to estimate both all-cause mortality risk and cardiovascular mortality, with serum potassium at 3.8–4.1 mmol/l as reference. After 90 days, the all-cause mortality in the six groups was 29.5%, 22.1%, 20.3%, 24.8%, 23.5% and 43.6%, respectively. In multivariable adjusted analysis, patients with serum potassium <3.5 mmol/l (hazard ratio: 1.51; 95% confidence interval: 1.13–2.02) and serum potassium 5.1–8.0 mmol/l (hazard ratio: 2.18; 95% confidence interval: 1.50–3.17) had an increased risk of all-cause mortality compared to the reference. After 90 days, the cardiovascular mortality in the six groups was 19.2%, 17.7%, 14.4%, 18.9%, 18.8% and 34.0%, respectively. In multivariable adjusted analysis, patients with serum potassium 5.1–8.0 mmol/l (hazard ratio: 2.32; 95% confidence interval: 1.51–3.56) had an increased risk of cardiovascular mortality compared to the reference, while serum potassium <3.5 mmol/l (hazard ratio: 1.37; 95% confidence interval: 0.97–1.95) had a trend toward increased risk of cardiovascular mortality compared to the reference. Conclusion Patients with chronic heart failure and hypokalaemia, who after 8–30 days remained hypokalaemic, had a significantly higher 90-day all-cause mortality risk compared to patients in the reference group (3.8–4.1 mmol/l). Patients with chronic heart failure and hypokalaemia, who after 8–30 days had the serum potassium level increased to a level within 5.1–8.0 mmol/l, had both a significantly higher 90-day all-cause mortality risk and cardiovascular mortality risk compared to patients in the reference group (3.8–4.1 mmol/l).

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The prognostic importance of serum sodium levels at hospital discharge and one‐year mortality among hospitalized patients

International Journal of Clinical Practice ◽

10.1111/ijcp.13581 ◽

2020 ◽

Vol 74 (10) ◽

Author(s):

Charat Thongprayoon ◽

Wisit Cheungpasitporn ◽

Tananchai Petnak ◽

Ranine Ghamrawi ◽

Sorkko Thirunavukkarasu ◽

...

Keyword(s):

Hospital Discharge ◽

Serum Sodium ◽

Hospitalized Patients ◽

Prognostic Importance ◽

One Year

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Subtyping Hyperchloremia among Hospitalized Patients by Machine Learning Consensus Clustering

Medicina ◽

10.3390/medicina57090903 ◽

2021 ◽

Vol 57 (9) ◽

pp. 903 ◽

Cited By ~ 2

Author(s):

Charat Thongprayoon ◽

Voravech Nissaisorakarn ◽

Pattharawin Pattharanitima ◽

Michael A. Mao ◽

Andrea G. Kattah ◽

...

Keyword(s):

Machine Learning ◽

Cluster Analysis ◽

Serum Sodium ◽

Hospitalized Patients ◽

Lower Serum ◽

Comorbidity Score ◽

Mortality Risks ◽

Serum Chloride ◽

One Year ◽

Cluster 2

Background and Objectives: Despite the association between hyperchloremia and adverse outcomes, mortality risks among patients with hyperchloremia have not consistently been observed among all studies with different patient populations with hyperchloremia. The objective of this study was to characterize hyperchloremic patients at hospital admission into clusters using an unsupervised machine learning approach and to evaluate the mortality risk among these distinct clusters. Materials and Methods: We performed consensus cluster analysis based on demographic information, principal diagnoses, comorbidities, and laboratory data among 11,394 hospitalized adult patients with admission serum chloride of >108 mEq/L. We calculated the standardized mean difference of each variable to identify each cluster’s key features. We assessed the association of each hyperchloremia cluster with hospital and one-year mortality. Results: There were three distinct clusters of patients with admission hyperchloremia: 3237 (28%), 4059 (36%), and 4098 (36%) patients in clusters 1 through 3, respectively. Cluster 1 was characterized by higher serum chloride but lower serum sodium, bicarbonate, hemoglobin, and albumin. Cluster 2 was characterized by younger age, lower comorbidity score, lower serum chloride, and higher estimated glomerular filtration (eGFR), hemoglobin, and albumin. Cluster 3 was characterized by older age, higher comorbidity score, higher serum sodium, potassium, and lower eGFR. Compared with cluster 2, odds ratios for hospital mortality were 3.60 (95% CI 2.33–5.56) for cluster 1, and 4.83 (95% CI 3.21–7.28) for cluster 3, whereas hazard ratios for one-year mortality were 4.49 (95% CI 3.53–5.70) for cluster 1 and 6.96 (95% CI 5.56–8.72) for cluster 3. Conclusions: Our cluster analysis identified three clinically distinct phenotypes with differing mortality risks in hospitalized patients with admission hyperchloremia.

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Abstract 433: Serum Chloride is an Independent and Robust Predictor of Mortality Than Serum Sodium, Potassium or Bicarbonate in Hypertensive Patients

Hypertension ◽

10.1161/hyp.60.suppl_1.a433 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Linsay McCallum ◽

Panniyammakkal Jeemon ◽

Matthew Walters ◽

Scott Muir ◽

Anna F Dominiczak ◽

...

Keyword(s):

Serum Sodium ◽

Proportional Hazards ◽

Reference Group ◽

Cox Proportional Hazards ◽

Serum Electrolytes ◽

Hypertensive Patients ◽

Serum Chloride ◽

Unit Increase ◽

Design And Methods

Objectives: Extremes of serum Na + , K + and HCO 3 have been associated with poorer outcomes. The role of serum Cl - has been largely considered to be linked to serum Na + and HCO 3 levels. Design and Methods: We studied the association of serum and other serum electrolytes in relation to mortality outcomes in 13,415 hypertensive patients attending the Glasgow Blood Pressure Clinic (GBPC) with serum Cl - assessed at the registration visit. Cox proportional hazards (Cox-PH) models were used for survival analysis. To determine whether Cl - effects are independent of low serum sodium, we performed the analysis in subjects with Na + >135 and stratified by Na + and Cl - levels. Results: The total time at risk was 197,101 person years during which 3,373 all-cause deaths occurred. Compared to quintile 1 (Cl - <=100), each higher quintile of Cl - was associated with lower mortality (H.R.[95%C.I.]0.82[0.74-0.90];0.79[0.71-0.87];0.79[0.70-0.89];0.80[0.68-0.93]) after adjustment for all conventional risk factors, other serum electrolytes and diuretic use (Figure-1). In the subset with Na + >135, each unit increase in Cl - was associated with a 3% reduction in mortality(H.R =0.97 CI:0.96-0.98). Finally subjects with Na + >135&Cl - >100(reference) had the best survival and those with Na + <135 and Cl - <100 the poorest survival. The group with normal Na + >135 and Cl - <100 had significantly higher mortality than the reference group (1.21[1.11-1.31]). Conclusion: Serum Cl - independently predicts mortality outcomes in the hypertensive population irrespective of serum Na + , K + and HCO 3 levels.

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Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA

BMJ Open ◽

10.1136/bmjopen-2019-034325 ◽

2020 ◽

Vol 10 (3) ◽

pp. e034325 ◽

Cited By ~ 3

Author(s):

Charat Thongprayoon ◽

Wisit Cheungpasitporn ◽

Api Chewcharat ◽

Michael A Mao ◽

Kianoush B Kashani

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Primary Outcome ◽

Reference Group ◽

Tertiary Referral Hospital ◽

Hospitalised Patients ◽

Increased Risk ◽

Ionised Calcium

ObjectivesThe objective of this study was to evaluate the risk of acute respiratory failure in all hospitalised patients based on admission serum ionised calcium.DesignA retrospective cohort study.SettingA tertiary referral hospital in Rochester, Minnesota, USA.ParticipantsAll hospitalised patients who had serum ionised calcium measurement within 24 hours of hospital admission from January 2009 to December 2013. Patients who were mechanically ventilated at admission were excluded.PredictorsAdmission serum ionised calcium levels was stratified into six groups: ≤4.39, 4.40–4.59, 4.60–4.79, 4.80–4.99, 5.00–5.19 and ≥5.20 mg/dL.Primary outcome measureThe primary outcome was the development of acute respiratory failure requiring mechanical ventilation during hospitalisation. Logistic regression analysis was fit to assess the independent risk of acute respiratory failure based on various admission serum ionised calcium, using serum ionised calcium of 5.00–5.19 mg/dL as the reference group.ResultsOf 25 709 eligible patients, with the mean serum ionised calcium of 4.8±0.4 mg/dL, acute respiratory failure requiring mechanical ventilation occurred in 2563 patients (10%). The incidence of acute respiratory failure was lowest when admission serum ionised calcium was 5.00–5.19 mg/dL, with the progressively increased risk of acute respiratory failure with decreased serum ionised calcium. In multivariate analysis with adjustment for potential confounders, the increased risk of acute respiratory failure requiring mechanical ventilation was significantly associated with admission serum ionised calcium of ≤4.39 (OR 2.52; 95% CI 2.12 to 3.00), 4.40–4.59 (OR 1.76; 95% CI 1.49 to 2.07) and 4.60–4.79 mg/dL (OR 1.48; 95% CI 1.27 to 1.72), compared with serum ionised calcium of 5.00–5.19 mg/dL. The risk of acute respiratory failure was not significantly increased when serum ionised calcium was at least 4.80 mg/dL.ConclusionThe increased risk of acute respiratory failure requiring mechanical ventilation was observed when admission serum ionised calcium was lower than 4.80 mg/dL in hospitalised patients.

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