Determination of Association of Hyperchloremia with Rise in Inflammatory Markers, Serum Creatinine and Anaemia in COVID-19 Patients in Intensive Care Unit – A Prospective Follow-up Study

Vedaghosh Amara,P Vishwas,N R Arjun,Shwethapriya Rao,Souvik Chaudhuri

doi:10.4038/slja.v29i2.8882

Abstract

Hyperchloremia leads to adverse effects like increase in pro-inflammatory mediators, anaemia and renal dysfunction. Aim of this study is to determine the association of hyperchloremia with rise in C-reactive protein (CRP), serum ferritin, lactate dehydrogenase (LDH), serum creatinine and anaemia in COVID-19 patients in intensive care unit (ICU). It was a single-centre study, 62 COVID-19 patients participated. Change in CRP, serum ferritin, LDH, serum creatinine, haemoglobin between day one and day three of ICU admission were noted. Outcome in terms of in-hospital mortality was noted. Hyperchloremia (>106mmol/L) or rise in chloride by > 5mmol/L was seen in 13/62 (20.96%) patients. It was not associated with a rise in CRP, ferritin, LDH, creatinine, drop in hemoglobin within 72 hours or in-hospital mortality. 44/62 (71%) patients survived and were discharged from hospital. Multivariate logistic regression showed that if age and gender are also considered, there is a 25 times higher chance of having had a significant ferritin rise (> 95 ng/mL) in 72 hours of ICU admission among those who died. (p=0.01). Hyperchloremia (>106mmol/L) or a rise in chloride by > 5mmol/L in 72 hours of ICU admission was not associated with a significant increase in CRP, LDH, ferritin, serum creatinine within 72 hours of ICU admission or mortality in moderate-severe COVID-19 patients. If age and gender are taken into consideration, there is a 25 times higher chance of having had a significant ferritin rise (> 95 ng/mL) in 72 hours of ICU admission among those who died.

Highlights

Hyperchloremia has deleterious effects in critically ill, like accentuation of metabolic acidosis and inflammatory process, hemodynamic instability, acute kidney injury, and anaemia.[1,2] Hyperchloremia, defined as serum chloride level >106-111 mmol/L, according to laboratory values.[3]
C-reactive protein (CRP), ferritin and lactate dehydrogenase (LDH) are important prognostic mediators in patients with COVID-19.6,7 We conducted this study to determine association of hyperchloremia or a 72 hour rise in chloride level with a 72 hour rise in CRP, ferritin and LDH in moderate-severe COVID-19 patients, and to assess if serum chloride can serve as a surrogate of these expensive markers in resource limited settings
The number of patients who had a rise in CRP (>10mg/L), ferritin (> 95ng/mL) and LDH (>238U/L) between day one and day three was 18 (29%), 19 (30.6%) and 10 (16.12%) respectively. 28 patients had a drop in haemoglobin >0.5g/dL

Summary

Introduction

Hyperchloremia has deleterious effects in critically ill, like accentuation of metabolic acidosis and inflammatory process, hemodynamic instability, acute kidney injury, and anaemia.[1,2] Hyperchloremia, defined as serum chloride level >106-111 mmol/L, according to laboratory values.[3] At our institute, it is compatible with a chloride level >106 mmol/L.3. To the best of our knowledge, similar study has not been done

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