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Association of serum chloride level alterations with in-hospital mortality
  1. Charat Thongprayoon1,
  2. Wisit Cheungpasitporn2,
  3. Panupong Hansrivijit3,
  4. Sorkko Thirunavukkarasu1,
  5. Api Chewcharat1,
  6. Juan Medaura2,
  7. Michael A Mao4,
  8. Kianoush Kashani1
  1. 1Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
  2. 2Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
  3. 3Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
  4. 4Division of Nephrology and Hypertension, Mayo Clinic Florida, Jacksonville, Florida, USA
  1. Correspondence to Dr Kianoush Kashani, Mayo Clinic Rochester, Rochester, MN 55905-0002, USA; kashani.kianoush{at}


Background We aimed to assess the association between alterations in serum chloride levels during hospitalisation and mortality.

Methods We reviewed all adult patients admitted to our hospital from the year 2009 to 2013, who had at least two serum chloride measurements during hospitalisation. The serum chloride change during hospitalisation, defined as the absolute difference between the highest and lowest serum chloride levels, was categorised into seven groups; 0–2, 3–4, 5–6, 7–8, 9–10, 11–12 and ≥13 mEq/L. Multivariable logistic regression was performed to assess the independent association between serum chloride change and in-hospital mortality, using the serum chloride change of 0–2 mEq/L as the reference group.

Results A total of 57 880 patients, with median serum chloride change of 5 (IQR 3–9) mEq/L, were studied. The in-hospital mortality was progressively increased with larger chloride change, from 0.6% in group of 0–2 mEq/L to 5.9% in group of ≥13 mEq/L (p<0.001). In adjusted analysis, serum chloride change of ≥7 mEq/L was significantly associated with increased in-hospital mortality. For upward trend, serum chloride change of ≥3 mEq/L was significantly associated with increased in-hospital mortality, whereas, for downward trend, serum chloride change was not consistently associated with in-hospital mortality.

Conclusion Alterations in serum chloride during hospitalisation were associated with increased hospital mortality. The association was more prominent with upward than downward trend of serum chloride.

  • nephrology
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  • Contributors CT, WC, and KK originated research idea. CT and WC designed the study. CT, WC, PH, ST, AC, JM and MAM collected data. CT analysed data. CT, WC and PH wrote manuscript. ST, AC, JM, MAM and KBK edited manuscript. KK supervised the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Mayo Clinic Institutional Review Board approved this study (IRB number 15-000024).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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