Abstract

Aim:
This study aimed to examine whether serum chloride concentrations obtained within the first 24 hours after intensive care unit (ICU) admission are associated with 28-day all-cause mortality in elderly patients with sepsis and to explore their potential prognostic value.
Materials and Methods:
This retrospective cohort study was conducted at a single center and involved 221 patients aged 65 years and older who were hospitalized in the ICU with sepsis between December 1, 2023 and May 31, 2024. The categorisation of patients was based on serum chloride levels measured within the first 24 hours. Patients were categorised as hypochloremic (110 mEq/L). Information on demographics, laboratory results and Acute Physiologic and Chronic Health Evaluation II (APACHE II) scoring was collected. Data analysis involved the Mann–Whitney U, chi-square, and logistic regression tests.
Results:
A total of 221 patients were evaluated, with a mean age of 80.87 ± 8.04 years. The 28-day all-cause mortality rate was found to be 67.4%.The prevalence of hyperchloremia (62.4%) was significantly higher compared to normochloremia (25.8%) and hypochloremia (11.8%). Multivariate logistic regression revealed that hyperchloremia independently predicted 28-day mortality (OR = 4.95; 95% CI, 1.51–16.21; p = 0.008). A rise in the APACHE II score was found to be a highly significant predictor of mortality (p < 0.001).
Conclusion: An independent link between high chloride levels and 28-day mortality was observed in elderly septic individuals requiring intensive care. Routine monitoring of serum chloride levels and careful management of chloride load may contribute to improving prognosis in this vulnerable patient population.

Key words: Sepsis; Chlorides; Mortality; Critical Care