Background

Recent data suggest that hyperchloremia induced by fluid resuscitation is associated with acute kidney injury (AKI) and mortality, particularly in sepsis. Experimental studies showed that hyperchloremia could affect organ functions. In patients with septic shock, we examined the relationship between serum chloride concentration and both renal function and survival.

Methods

Post hoc analysis of the “HYPER2S” trial database (NCT01722422) including 434 patients with septic shock randomly assigned for resuscitation with 0.9% or 3% saline. Metabolic parameters were recorded up to 72 h. Metabolic effects of hyperchloremia (> 110 mmol/L) were studied stratified for hyperlactatemia (> 2 mmol/L). Cox models were constructed to assess the association between chloride parameters, day-28 mortality and AKI.

Results

413 patients were analysed. The presence of hyperlactatemia was significantly more frequent than hyperchloremia (62% versus 71% of patients, respectively, p = 0.006). Metabolic acidosis was significantly more frequent in patients with hyperchloremia, no matter the presence of hyperlactatemia, p < 0.001. Adjusted risk of AKI and mortality were not significantly associated with serum chloride, hyperchloremia, maximal chloremia and delta chloremia (maximal-H0 [Cl]).

Conclusions

Despite more frequent metabolic acidosis, hyperchloremia was not associated with an increased risk for AKI or mortality.Trial registration ClinicalTrials.gov, identifier: NCT01722422, registered 2 November 2012

中文翻译：

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高氯血症与败血性休克患者的AKI或死亡无关：“ HYPER2S”试验的事后分析结果。

背景

最近的数据表明，液体复苏引起的高氯血症与急性肾损伤（AKI）和死亡率有关，尤其是在败血症中。实验研究表明，高氯血症可能会影响器官功能。在败血性休克患者中，我们检查了血清氯化物浓度与肾脏功能和生存之间的关系。

方法

对“ HYPER2S”试验数据库（NCT01722422）进行事后分析，包括434名败血症性休克患者，随机分配接受0.9％或3％盐水进行复苏。记录代谢参数长达72小时。高脂血症（> 2 mmol / L）分层研究了高氯血症（> 110 mmol / L）的代谢作用。构建考克斯模型以评估氯化物参数，第28天死亡率和AKI之间的关联。

结果

分析了413例患者。高乳酸血症的发生率明显高于高氯血症（分别为62％和71％的患者，p  = 0.006）。高氯血症患者中代谢性酸中毒的发生率明显更高，无论是否存在高乳酸血症，p  <0.001。调整后的AKI风险和死亡率与血清氯化物，高氯血症，最大氯血症和δ氯血症（最大H0 [Cl]）无显着相关。

结论

尽管代谢性酸中毒更加频繁，但高氯血症与AKI或死亡的风险增加无关。试验注册ClinicalTrials.gov，标识符：NCT01722422，2012年11月2日注册