Higher Fluid Balance Increases the Risk of Death From Sepsis: Results From a Large International Audit.

Sakr, Yasser; Rubatto Birri, Paolo Nahuel; Kotfis, Katarzyna; Nanchal, Rahul; Shah, Bhagyesh; Kluge, Stefan; Schroeder, Mary E; Marshall, John C; Vincent, Jean-Louis (2017). Higher Fluid Balance Increases the Risk of Death From Sepsis: Results From a Large International Audit. Critical care medicine, 45(3), pp. 386-394. Lippincott Williams & Wilkins 10.1097/CCM.0000000000002189

[img] Text
2017 - Sakr - CCM - PMID 27922878.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (397kB) | Request a copy

OBJECTIVES Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis. DESIGN Observational cohort study. SETTING Seven hundred and thirty ICUs in 84 countries. PATIENTS All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission. MEASUREMENTS AND MAIN RESULTS ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock. CONCLUSIONS In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0090-3493

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

14 Mar 2018 16:58

Last Modified:

29 Oct 2019 18:26

Publisher DOI:

10.1097/CCM.0000000000002189

PubMed ID:

27922878

Additional Information:

Autor Stephan Jakob, Universitätsklinik für Intensivmedizin, on behalf of Intensive Care Over Nations Investigators

BORIS DOI:

10.7892/boris.109773

URI:

https://boris.unibe.ch/id/eprint/109773

Actions (login required)

Edit item Edit item
Provide Feedback