Abstract
BackgroundIncreased chloride in the context of intravenous fluid chloride load and serum chloride levels (hyperchloremia) have previously been associated with increased morbidity and mortality in select subpopulations of intensive care unit (ICU) patients (e.g patients with sepsis). Here, we study the general ICU population of the Medical Information Mart for Intensive Care III (MIMIC-III) database to corroborate these associations, and propose a supervised learning model for the prediction of hyperchloremia in ICU patients.MethodsWe assessed hyperchloremia and chloride load and their associations with several outcomes (ICU mortality, new acute kidney injury [AKI] by day 7, and multiple organ dysfunction syndrome [MODS] on day 7) using regression analysis. Four predictive supervised learning classifiers were trained to predict hyperchloremia using features representative of clinical records from the first 24h of adult ICU stays.ResultsHyperchloremia was shown to have an independent association with increased odds of ICU mortality, new AKI by day 7, and MODS on day 7. High chloride load was also associated with increased odds of ICU mortality. Our best performing supervised learning model predicted second-day hyperchloremia with an AUC of 0.76 and a number needed to alert (NNA) of 7—a clinically-actionable rate.ConclusionsOur results support the use of predictive models to aid clinicians in monitoring for and preventing hyperchloremia in high-risk patients and offers an opportunity to improve patient outcomes.
Highlights
Increased chloride in the context of intravenous fluid chloride load and serum chloride levels have previously been associated with increased morbidity and mortality in select subpopulations of intensive care unit (ICU) patients (e.g patients with sepsis)
As there have been many promising developments in clinical event prediction using machine learning, we propose a predictive model for hyperchloremia using this Electronic Health Record (EHR) data
Univariate statistical analysis demonstrated that increased maximum serum chloride level, hyperchloremia (≥ 110 mEq/L), increased number of days in which hyperchloremia occurred, and increased chloride load in Hyperchloremic (n = 18181)
Summary
Increased chloride in the context of intravenous fluid chloride load and serum chloride levels (hyper‐ chloremia) have previously been associated with increased morbidity and mortality in select subpopulations of intensive care unit (ICU) patients (e.g patients with sepsis). Higher rates of in-hospital mortality were observed with elevated IV fluid chloride content during resuscitation with large fluid volumes [2] as well as in patients with sepsis [3]. Hyperchloremia in patients with sepsis has been linked to higher rates of acute kidney injury (AKI) [4] and mortality [5]. Low-chloride strategies demonstrated reductions in AKI and renal replacement therapy [6]. These findings warrant further investigation into the merits of shifting from the traditional approach of chloride-liberal fluid administration to a chloride-restrictive one, which could be of benefit to critically ill patients
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