Relationship Between Serum Chlorine And Renal Injury In Patients With Sepsis After Early Saline Resuscitation

Objective:To explore the relationship between serum chloridion concentration and its changes in patients with sepsis or septic shock after early 72 h resuscitation with saline solution and the occurrence and development of acute kidney injury(acute kidney injury,AKI).Methods:A retrospective cohort study was used to collect the clinical data of 200 patients with sepsis or septic shock who were admitted to the intensive care unit of the First Hospital of Shanxi Medical University from January 2015 to May 2019 and used saline for early fluid resuscitation.Data:According to serum chloridion concentration after 72 h of fluid resuscitation,the patients were divided into 105 cases of hyperchloremia group(≥110 mmol/L)and 95 cases of non-hyperchloremia group(<110 mmol /L).Collect general clinical data of 2 groups of patients、Chloride value [Cl-]0、creatinine value、highest serum chloride ion value [Cl-]max、creatinine value、initial acute physiology and chronic health status(acute physiology and chronic health,APACHE Ⅱ score)、mechanical ventilation 、 renal replacement therapy(renal replacement therapy,RRT)needs.The t test and χ2 test were used to compare the differences between the two groups of data,and the univariate regression analysis was used to test the relationship between [Cl-]0、[Cl-]max、Δ[Cl-] and AKI.The P <0.100 was used as the independent variable,and the incidence of AKI was used as the dependent variable.Multivariate regression analysis was used to analyze the factors affecting AKI.Results:There was no significant difference in the initial serum chloridion concentration [Cl-]0、genderage、and number of patients with basic diseases in the two groups(P> 0.05),while the initial acute physiology and chronic health status of the patients in the high chloride group(APACHE Ⅱ score)compared with the non-hyperchloride group,the difference was statistically significant(P = 0.045);the incidence of AKI in the non-hyperchloremic group was 14.73%(14/95)after 72 h of saline resuscitation,and The incidence of AKI in the symptomatic group was 38.09%(40/105).Compared with the latter,the difference was statistically significant(χ2 = 3.652,P = 0.016);mechanical ventilation(69.52% vs 40.00%),Compared with RRT(21.90% vs 9.47%)requirements,the differences were statistically significant(χ2 = 4.032,P = 0.011;χ2 =3.312,P = 0.044);univariate regression analysis showed that [Cl-]0 and AKI occurred Irrelevant(the odds ratio(odd ratios,OR)is 1.01,P = 0.421);while [Cl-]max、Δ[Cl-]have a certain correlation with the occurrence of AKI,when Δ[Cl-] increases by 1mmol/L,the AKI dominance ratio(OR)was 1.30(P = 0.002).When Δ[Cl-] increased by5.5 mmol/L,the AKI’s odds ratio(OR)rose to 5.71(P <0.001).Multivariate regression analysis showed that the initial acute physiology and chronic health status(APACHE Ⅱscore)、mechanical ventilation、[Cl-]max、Δ[Cl-] were related to the occurrence of AKI,P <0.05,and the difference was statistically significant.Conclusion:Serum hyperchloremia and changes in serum chloride ion concentration Δ[Cl-] that occur in patients with sepsis or septic shock after 72 h of early saline resuscitation are associated with the occurrence and development of AKI.Initial acute physiology and chronic health status(APACHE Ⅱ score),mechanical ventilation,[Cl-]max、Δ[Cl-] are risk factors for the occurrence of AKI.