Impact of Moderate Hyperchloremia on Clinical Outcomes in Intracerebral Hemorrhage Patients Treated With Continuous Infusion Hypertonic Saline: A Pilot Study

Crit Care Med. 2017 Sep;45(9):e947-e953. doi: 10.1097/CCM.0000000000002522.


Objectives: Hyperchloremia has been associated with increased morbidity and mortality in critically ill patients. While previous research has demonstrated an association between hypertonic saline and hyperchloremia, limited data exist in neurocritical care patients. The objective of this study is to determine the impact of moderate hyperchloremia (chloride ≥ 115 mmol/L) on clinical outcomes in intracerebral hemorrhage patients treated with continuous IV infusion 3% hypertonic saline.

Design: Multicenter, retrospective, propensity-matched cohort study.

Setting: Neurocritical care units at two academic medical centers with dedicated neurocritical care teams and comprehensive stroke center designation.

Patients: Intracerebral hemorrhage patients discharged between September 2011 and September 2015 were evaluated and matched 1:1 based on propensity scoring.

Interventions: Continuous IV infusion 3% hypertonic saline.

Measurements and main results: A total of 219 patients were included in the unmatched cohort (143 moderate hyperchloremia and 76 nonhyperchloremia) and 100 patients in the propensity-matched cohort. In-hospital mortality was significantly higher in those who developed moderate hyperchloremia in a propensity-matched cohort (34% vs 14%; p = 0.02). Moderate hyperchloremia independently predicted in-hospital mortality in multivariable logistic regression analysis (odds ratio, 4.4 [95% CI, 1.4-13.5]; p = 0.01).

Conclusions: We observed higher rates of in-hospital mortality in patients who developed moderate hyperchloremia during treatment with continuous IV infusion 3% hypertonic saline, with moderate hyperchloremia independently predicting in-hospital mortality. These results suggest that chloride values should be monitored closely during hypertonic saline treatment as moderate elevations may impact outcomes in intracerebral hemorrhage patients.

Publication types

  • Multicenter Study

MeSH terms

  • Academic Medical Centers
  • Adult
  • Aged
  • Cerebral Hemorrhage / mortality*
  • Cerebral Hemorrhage / therapy*
  • Chlorine / blood*
  • Critical Illness / therapy*
  • Female
  • Hospital Mortality
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Odds Ratio
  • Pilot Projects
  • Propensity Score
  • Retrospective Studies
  • Saline Solution, Hypertonic / adverse effects*
  • Saline Solution, Hypertonic / therapeutic use
  • Water-Electrolyte Imbalance


  • Saline Solution, Hypertonic
  • Chlorine