The Correlation of Serum Chloride Level and Hospital Mortality in Multiple Trauma Patients
Introduction: Electrolyte disorder is a prevalent complication in multiple trauma patients; nevertheless, the role of chloride has been rarely addressed in literature when evaluating serum electrolytes. Objective: The present study was conducted to determine the correlation between serum chloride changes and hospital mortality in multiple trauma patients. Method: The present cross-sectional study measured serum chloride levels in 100 multiple trauma patients upon their admission to the emergency department and 24 hours later. All these patients were followed up in terms of hospital mortality using their medical records. Exact logistic regression was used to measure the effects of independent variables on hospital mortality in the patients. Results: Hospital mortality was found to be 15 (15%), and the mean serum chloride level to be 106.37±4.53 mmol/l upon admission and 112.18±6.16 mmol/l 24 hours later. Although the univariate analysis suggested that serum chloride levels were independently associated with mortality 24 hours after admission (P=0.005), this correlation was insignificant in the multivariate analysis. Conclusion: The present study rejected the hypothesis suggesting the potential role of serum chloride levels in predicting hospital mortality in multiple trauma patients.
2. Torabi M, Mehri A, Mirzaei M. The effect of pain management in reducing limb and spine radiography in stable traumatic patients admitted to the emergency department. Trauma. 2019;21(2):107-12.
3. Torabi M, Abadi FM, Baneshi MR. Blood sugar changes and hospital mortality in multiple trauma. The Am J Emerg Med. 2018;36(5):816-9.
4. Frink M, Lechler P, Debus F, Ruchholtz S. Multiple trauma and emergency room management. Dtsch Arztebl Int. 2017 Jul; 114(29-30): 497–503..
5. Dadoo S, Grover JM, Keil LG, Hwang KS, Brice JH, Platts-Mills TF. Prehospital fluid administration in trauma patients: a survey of state protocols. Prehosp Emerg Care. 2017;21(5):605-9.
6. Harris T, Davenport R, Mak M, Brohi K. The evolving science of trauma resuscitation. Emerg Med Clin North Am. 2018;36(1):85-106.
7. Berend K, van Hulsteijn LH, Gans RO. Chloride: the queen of electrolytes? Eur J Intern Med. 2012;23(3):203-11.
8. Schreiber MA, Meier EN, Tisherman SA, Kerby JD, Newgard CD, Brasel K, et al. A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients: results of a prospective randomized pilot trial. J Trauma Acute Care Surg. 2015;78(4):687-95.
9. Myburgh JA. Fluid resuscitation in acute medicine: what is the current situation? J Intern Med. 2015;277(1):58-68.
10. Krajewski ML, Raghunathan K, Paluszkiewicz SM, Schermer CR, Shaw AD. Meta‐analysis of high‐versus low‐chloride content in perioperative and critical care fluid resuscitation. Br J Surg. 2015;102(1):24-36.
11. Feinman M, Cotton BA, Haut ER. Optimal fluid resuscitation in trauma: type, timing, and total. Curr Opin Crit Care. 2014;20(4):366-72.
12. Chatrath V, Khetarpal R, Ahuja J. Fluid management in patients with trauma: Restrictive versus liberal approach. J Anaesthesiol Clin Pharmacol. 2015;31(3):308-16.
13. Lawless RA, Cotton BA. Adjuncts to Resuscitation. InDamage Control in Trauma Care 2018 (pp. 233-246). Springer, Cham.
14. Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:17.
15. McCluskey SA, Karkouti K, Wijeysundera D, Minkovich L, Tait G, Beattie WS. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: a propensity-matched cohort study. Anesth Analg. 2013;117(2):412-21.
16. Shaw AD, Raghunathan K, Peyerl FW, Munson SH, Paluszkiewicz SM, Schermer CR. Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS. Intensive Care Med. 2014;40(12):1897-905.
17. Scheingraber S, Rehm M, Sehmisch C, Finsterer U. Rapid Saline Infusion Produces Hyperchloremic Acidosis in Patients Undergoing Gynecologic Surgery. Anesthesiology. 1999;90(5):1265-70.
18. Neyra JA, Canepa-Escaro F, Li X, Manllo J, Adams-Huet B, Yee J, et al. Association of hyperchloremia with hospital mortality in critically ill septic patients. Crit Care Med. 2015 Sep;43(9):1938-44.
19. Lee JY, Hong TH, Lee KW, Jung MJ, Lee JG, Lee SH. Hyperchloremia is associated with 30-day mortality in major trauma patients: a retrospective observational study. Scand J Trauma Resusc Emerg Med. 2016;24(1):117.
20. Wilcox CS. Regulation of renal blood flow by plasma chloride. J Clin Invest. 1983;71(3):726-35.
21. Bullivant EM, Wilcox CS, Welch WJ. Intrarenal vasoconstriction during hyperchloremia: role of thromboxane. Am J Physiol. 1989;256(1):F152-7.
22. Kellum JA, Song M, Almasri E. Hyperchloremic acidosis increases circulating inflammatory molecules in experimental sepsis. Chest. 2006;130(4):962-7.
23. Boniatti MM, Cardoso PR, Castilho RK, Vieira SR. Is hyperchloremia associated with mortality in critically ill patients? A prospective cohort study. J Crit Care. 2011;26(2):175-9.
This journal be published an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/) which permits anyone to copy, redistribute, remix, transmit and adapt the work provided the original work and source is appropriately cited.