Abstract
IntroductionEarly fluid balance has been found to affect short-term mortality in critically ill patients; however, there is little knowledge regarding the association between early cumulative fluid balance (CFB) and long-term mortality. This study aims to determine the distinct association between CFB day 1–3 (CFB 1–3) and day 4–7 (CFB 4–7) and long-term mortality in critically ill patients.Patients and MethodsThis study was conducted at Taichung Veterans General Hospital, a tertiary care referral center in central Taiwan, by linking the hospital critical care data warehouse 2015–2019 and death registry data of the Taiwanese National Health Research Database. The patients followed up until deceased or the end of the study on 31 December 2019. We use the log-rank test to examine the association between CFB 1–3 and CFB 4–7 with long-term mortality and multivariable Cox regression to identify independent predictors during index admission for long-term mortality in critically ill patients.ResultsA total of 4,610 patients were evaluated. The mean age was 66.4 ± 16.4 years, where 63.8% were men. In patients without shock, a positive CFB 4–7, but not CFB 1–3, was associated with 1-year mortality, while a positive CFB 1–3 and CFB 4–7 had a consistent and excess hazard of 1-year mortality among critically ill patients with shock. The multivariate Cox proportional hazard regression model identified that CFB 1–3 and CFB 4–7 (with per 1-liter increment, HR: 1.047 and 1.094; 95% CI 1.037–1.058 and 1.080–1.108, respectively) were independently associated with high long-term mortality in critically ill patients after adjustment of relevant covariates, including disease severity and the presence of shock.ConclusionsWe found that the fluid balance in the first week, especially on days 4–7, appears to be an early predictor for long-term mortality in critically ill patients. More studies are needed to validate our findings and elucidate underlying mechanisms.
Highlights
Fluid balance has been found to affect short-term mortality in critically ill patients; there is little knowledge regarding the association between early cumulative fluid balance (CFB) and long-term mortality
One recent meta-analysis found that a positive cumulative fluid balance (CFB) in the first 3 days of intensive care unit (ICU) stay was associated with high hospital mortality [Relative Risk 2.15] [8]
Non-survivors compared with survivors had a significantly lower body mass index, a higher Charlson Comorbidity Index (CCI), a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, more mechanical ventilation, and a higher percent of shock
Summary
Fluid balance has been found to affect short-term mortality in critically ill patients; there is little knowledge regarding the association between early cumulative fluid balance (CFB) and long-term mortality. This study aims to determine the distinct association between CFB day 1–3 (CFB 1–3) and day 4–7 (CFB 4–7) and long-term mortality in critically ill patients. Increasing evidence has suggested that a positive fluid balance in the early stage of ICU admission might deteriorate outcomes in critically ill patients [4–7]. One recent meta-analysis found that a positive cumulative fluid balance (CFB) in the first 3 days of ICU stay was associated with high hospital mortality [Relative Risk 2.15 (95% CI, 1.51–3.07)] [8]. The optimal management of post-resuscitation fluid management, such as the day 4– 7 fluid balance, remains unclear. Few studies have explored the association between early fluid balance and longterm survival [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
