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

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.