313 Outcomes for Patients With Congestive Heart Failure and Chronic Kidney Disease Receiving Fluid Resuscitation for Severe Sepsis or Septic Shock

Abstract

Sepsis core measures are an integral part of sepsis treatment. Current fluid administration guidelines consist of administering at least 30cc/kg of intravenous fluids (IVF) per ideal body weight (IBW) within the first three hours of sepsis diagnosis regardless of pre-existing comorbidities at risk for fluid overload. This study aims to evaluate the outcomes of patients with a history of congestive heart failure (CHF) and/or chronic kidney disease (CKD) who receive fluid resuscitation for the management of severe sepsis or septic shock. We performed a retrospective case-control study of emergency department patients treated for severe sepsis or septic shock between April 2018 and May 2019. Subjects were identified from an electronic medical record query from 3 community hospitals, using ICD-10 codes. We identified subjects with a history of CHF or CKD (at-risk group [AR]) and a sample of patients without a history of CHF/ CKD (control group). We performed a structured chart review recording demographics, fluids received, airway interventions required, and outcome. Logistic regression analysis was used to compare the association between the amount of IV fluids received and the outcomes of interest (advance airway management and hospital mortality). Log-Rank test was used to adjust for multiple comparisons in survival analysis. Our cohort consisted of 745 patients with a history of CHF and/or CKD (AR group) and 570 patients without a history of CHF and/or CKD (control group). The mean age of patients in the AR group was 73.1 (SD 14.14) vs. 64.3 (16.9) in the control group (p-value <0.001). The initial mean lactate was similar in both the AR group= 3.02 (2.32) vs. the control group = 3.12 (2.44) (p-value=0.478). Overall patients in the AR group received less IVFs than the control group at 24 hours (2530.6 vs 3046.7, p-value=0.001). In the control group 50 (9%) vs 126 (17%) in the AR group required BiPAP during their hospitalization. There was a significant association between receipt of >30cc/kg of IVF in the AR group at 3hrs and 6hrs from ED arrival and the need for BiPAP (p-value=0.006, p=0.02, respectively). In-hospital mortality was found in 96 (13%) of the AR group vs 47 (8%) of the control group (p-value= 0.007). There was no statistically significant association between receipt of >30 cc/kg of IVF in the AR group compared to the control group at 3 or at 6 hrs from ED arrival in terms of in-hospital mortality (p-value=0.614, p=0.115, respectively). We identified a significant association of >30 cc/kg IVF administration and the need for Bi-PAP in AR patients. We identified higher in-hospital mortality in the AR group, but this was not associated with the amount of IVF resuscitation received. Further prospective studies that specifically identify at-risk populations receiving IVF resuscitation can better define the true risk for need for respiratory support.View Large Image Figure ViewerDownload Hi-res image Download (PPT)