Association between Serum Chloride Levels and Prognosis in Patients with Hepatic Coma in the Intensive Care Unit.

Shu Xing WEI; Xi Ya WANG; Yuan DU; Ying CHEN; Jin Long WANG; Yue HU; Wen Qing JI; Xing Yan ZHU; Xue MEI; Da ZHANG

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Association between Serum Chloride Levels and Prognosis in Patients with Hepatic Coma in the Intensive Care Unit.

Author: Shu Xing WEI ¹ ; Xi Ya WANG ¹ ; Yuan DU ² ; Ying CHEN ¹ ; Jin Long WANG ¹ ; Yue HU ¹ ; Wen Qing JI ¹ ; Xing Yan ZHU ³ ; Xue MEI ¹ ; Da ZHANG ¹
Author Information

1. Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing 100020, China.
2. Department of Infectious Diseases (Fever Clinic), Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Dongcheng District, Beijing 100010, China.
3. CMAC Healthcare Communications Limited, Chaoyang District, Beijing 100020, China.
Publication Type:Journal Article
Keywords: Chloride; Hepatic coma; Intensive care unit; Mortality
MeSH: Humans; Male; Female; Middle Aged; Intensive Care Units; Prognosis; Chlorides/blood*; Aged; Coma/blood*; Adult
From: Biomedical and Environmental Sciences 2025;38(10):1255-1269
CountryChina
Language:English
Abstract: OBJECTIVE:To explore the relationship between serum chloride levels and prognosis in patients with hepatic coma in the intensive care unit (ICU).
METHODS:We analyzed 545 patients with hepatic coma in the ICU from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Associations between serum chloride levels and 28-day and 1-year mortality rates were assessed using restricted cubic splines (RCSs), Kaplan-Meier (KM) curves, and Cox regression. Subgroup analyses, external validation, and mechanistic studies were also performed.
RESULTS:A total of 545 patients were included in the study. RCS analysis revealed a U-shaped association between serum chloride levels and mortality in patients with hepatic coma. The KM curves indicated lower survival rates among patients with low chloride levels (< 103 mmol/L). Low chloride levels were independently linked to increased 28-day and 1-year all-cause mortality rates. In the multivariate models, the hazard ratio ( HR) for 28-day mortality in the low-chloride group was 1.424 (95% confidence interval [ CI]: 1.041-1.949), while the adjusted hazard ratio for 1-year mortality was 1.313 (95% CI: 1.026-1.679). Subgroup analyses and external validation supported these findings. Cytological experiments suggested that low chloride levels may activate the phosphorylation of the NF-κB signaling pathway, promote the expression of pro-inflammatory cytokines, and reduce neuronal cell viability.
CONCLUSION:Low serum chloride levels are independently associated with increased mortality in patients with hepatic coma.