Intensive Care Medicine

, Volume 44, Issue 12, pp 2183–2191 | Cite as

Increase in chloride from baseline is independently associated with mortality in critically ill children

  • Matthew F. BarhightEmail author
  • John Brinton
  • Timothy Stidham
  • Danielle E. Soranno
  • Sarah Faubel
  • Benjamin R. Griffin
  • Jens Goebel
  • Peter M. Mourani
  • Katja M. Gist
Pediatric Original



To determine if there is an association between mortality and admission chloride levels and/or increases in the chloride level in critically ill children.


We performed a retrospective cohort study of all patients admitted to the paediatric intensive care unit (PICU) from January 2014 to December 2015. Patients were excluded for the following reasons: (1) age < 90 days or > 18 years, (2) admission to the cardiac intensive care unit, (3) no laboratory values upon admission to the PICU, (4) history of end-stage renal disease, (5) a disorder of chloride transport, and (6) admission for diabetic ketoacidosis. The patients were stratified on the basis of admission chloride levels (hypochloraemia, < 96 mEq/L; normochloraemia, 96–109 mEq/L; and hyperchloraemia, ≥ 110 mEq/L) and dichotomised on the basis of an increase in chloride in the first day (< 5 mEq/L, ≥ 5 mEq/L). Our primary outcome was in-hospital mortality.


A total of 1935 patients [55% female, median age 6.3 years IQR (1.9–13.4)] were included. The overall mortality was 4% (n = 71) and day 2 AKI occurred in 17% (n = 333. Hypochloraemia, hyperchloraemia, and an increase in serum chloride ≥ 5 mEq/L occurred in 2%, 21%, and 12%, respectively. After adjusting for confounders, increase in chloride ≥ 5 mEq/L was associated with a 2.3 (95% CI 1.03–5.21) greater odds of mortality.


An increase in serum chloride level in the first day of admission is common and an independent risk factor for mortality in critically ill children. Further studies are warranted to identify how chloride disturbances contribute to mortality risk in critically ill children.


Hyperchloraemia Hypochloraemia Fluid overload Acute kidney injury Mortality Paediatric 


Compliance with ethical standards

Conflicts of interest

The authors have no financial or ethical conflicts of interest to disclose.

Supplementary material

134_2018_5424_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Matthew F. Barhight
    • 1
    Email author return OK on get
  • John Brinton
    • 5
  • Timothy Stidham
    • 6
  • Danielle E. Soranno
    • 3
    • 7
  • Sarah Faubel
    • 7
  • Benjamin R. Griffin
    • 7
  • Jens Goebel
    • 3
  • Peter M. Mourani
    • 2
  • Katja M. Gist
    • 4
  1. 1.Division of Critical Care, Ann & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Sections of Critical Care, Department of Paediatrics, University of Colorado School of MedicineAnschutz Medical Campus and Children’s Hospital ColoradoAuroraUSA
  3. 3.Sections of Nephrology, Department of Paediatrics, University of Colorado School of MedicineAnschutz Medical Campus and Children’s Hospital ColoradoAuroraUSA
  4. 4.Sections of Cardiology, Department of Paediatrics, University of Colorado School of MedicineAnschutz Medical Campus and Children’s Hospital ColoradoAuroraUSA
  5. 5.Department of Biostatistics and Informatics, University of Colorado School of Public HealthAnschutz Medical CampusAuroraUSA
  6. 6.Division of Critical CareKalispell Regional HealthcareKalispellUSA
  7. 7.Division of Renal Disease and Hypertension, Department of Medicine, University of Colorado School of MedicineAnschutz Medical CampusAuroraUSA

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