732: FLUID OVERLOAD IS ASSOCIATED WITH WORSENED HEALTH-RELATED QUALITY OF LIFE AFTER PEDIATRIC SEPSIS

Abstract

Introduction: Children with sepsis are at high risk of developing fluid overload (FO), a modifiable risk factor independently associated with hospital mortality and morbidity such as fewer ventilator-free days and acute kidney injury (AKI). We aimed to evaluate the association between FO and health-related quality of life (HRQL) outcomes in children with sepsis. Methods: We performed a secondary analysis of the LAPSE study, a prospective observational study that evaluated long-term outcomes in children after sepsis. Patients who received dialysis, were transferred out of PICU, or died by day 4 were excluded. Only PICU fluids were included and FO was defined as 100 x [(net fluid input – net fluid output)]/admission weight]. Three subgroups were identified: low FO (5%), medium FO (5%-15%) and high FO (>15%) based on cumulative FO on days 0-3 of ICU stay. Proxy-report of HRQL was measured to reflect pre-illness baseline and 1 month post-admission using the PedsQL or FS-IIR for patients with significant developmental delay. The primary outcome was 28 day mortality or >25% decline in HRQL score. Multivariable regression analyses were performed and adjusted for the following a priori potential confounding variables: age, PRISM-III score, presence of complex chronic disease, baseline HRQL, and early severe AKI (KDIGO stage 2-3 on day 0-1). Results: 293 patients were included of whom 66 (23%) had low FO, 127 (43%) medium FO, and 100 (34%) high FO. 275 (94%) survived to hospital discharge. There was no difference in PRISM-III scores. In multivariable analysis, mortality or >25% decline in HRQL was independently associated with low FO (OR 2.79; 95%CI 1.20, 6.57) and high FO (OR 2.16; 95%CI 1.06, 4.47) relative to the medium FO group (p 0.03). For every 1 point increase in baseline HRQL, the odds of mortality or >25% decline HRQL increased by 2% for the entire cohort (OR 1.02; 95% CI 1.00, 1.04; p 0.04). Conclusions: Children with sepsis who had < 5% or >15% FO during days 0-3 of PICU admission were more than twice as likely to suffer death or significant decline in HRQL compared to children with 5-15% FO. Prospective studies are needed to determine if adverse HRQL outcomes are modifiable as positive FB is modulated.