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Pancreatology. 2019 Jan;19(1):136-142. doi: 10.1016/j.pan.2018.11.006. Epub 2018 Nov 17.

Increase in serum chloride and chloride exposure are associated with acute kidney injury in moderately severe and severe acute pancreatitis patients.

Author information

1
Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Clinical Medical College of Southern Medical University, No.305 Zhongshan East Road, Nanjing, China; Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No.305 Zhongshan East Road, Nanjing, China.
2
Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Clinical Medical College of Nanjing Medical University, No.305 Zhongshan East Road, Nanjing, China.
3
Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Clinical Medical College of Southeast University, No.305 Zhongshan East Road, Nanjing, China.
4
Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No.305 Zhongshan East Road, Nanjing, China.
5
Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No.305 Zhongshan East Road, Nanjing, China. Electronic address: kkb9832@gmail.com.

Abstract

OBJECTIVE:

We aimed to evaluate whether early (first 48 h) hyperchloremia and/or the change of serum chloride concentration are associated with acute kidney injury (AKI) in patients with moderately severe and severe acute pancreatitis (MSAP and SAP).

METHODS:

We retrospectively collected the data of patients with a primary diagnosis of MSAP or SAP from a tertiary center between January 2014 and June 2017. Consecutive chloride levels within the first 48 h after admission were retrieved for further calculation. Logistic regression analysis and receiving operating characteristic (ROC) curve were used to assess the relationship between hyperchloremia and AKI.

RESULTS:

145 patients were enrolled for analysis, of whom 33.5% (47/145) developed hyperchloremia during the observation period. The incidence of AKI was significantly higher in the hyperchloremia group (40.4% vs 7.1%; p < 0.001). On multivariate analysis, the increase in serum chloride (Δ[Cl-]) was independently associated with AKI [OR = 1.32 (1.00-1.74)], as was chloride exposure [OR = 1.01 (1.00-1.02)], and these associations were found to be stronger in patients identified as predicted SAP (PSAP). Moreover, even in patients without hyperchloremia, increase in serum chloride (Δ[Cl-]) was still associated with AKI [OR = 1.65 (1.18-2.32)]. Area under the curve of the ROC curve (AUCROC) analysis found that Δ[Cl-] is a good predictor of AKI with an optimal cutoff point at 3.5 mmol/L, showing an AUCROC of 0.81.

CONCLUSION:

Hyperchloremia is common in patients with AP and Δ[Cl-] and chloride exposure during the first 48 h were independent risk factors for AKI in MSAP and SAP patients.

KEYWORDS:

Acute kidney injury; Chloride; Hyperchloremia; Severe acute pancreatitis

PMID:
30473463
DOI:
10.1016/j.pan.2018.11.006
[Indexed for MEDLINE]

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