Abstract
BackgroundSeptic shock has a high incidence and mortality rate in Intensive Care Units (ICUs). Earlier intravenous fluid resuscitation can significantly improve outcomes in septic patients but easily leads to fluid overload (FO), which is associated with poor clinical outcomes. A single point value of fluid cannot provide enough fluid information. The aim of this study was to investigate the impact of fluid balance (FB) latent trajectories on clinical outcomes in septic patients.MethodsPatients were diagnosed with septic shock during the first 48 h, and sequential fluid data for the first 3 days of ICU admission were included. A group-based trajectory model (GBTM) which is designed to identify groups of individuals following similar developmental trajectories was used to identify latent subgroups of individuals following a similar progression of FB. The primary outcomes were hospital mortality, organ dysfunction, major adverse kidney events (MAKE) and severe respiratory adverse events (SRAE). We used multivariable Cox or logistic regression analysis to assess the association between FB trajectories and clinical outcomes.ResultsNine hundred eighty-six patients met the inclusion criteria and were assigned to GBTM analysis, and three latent FB trajectories were detected. 64 (6.5%), 841 (85.3%), and 81 (8.2%) patients were identified to have decreased, low, and high FB, respectively. Compared with low FB, high FB was associated with increased hospital mortality [hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.22–2.17], organ dysfunction [odds ratio (OR) 2.18, 95% CI 1.22–3.42], MAKE (OR 1.80, 95% CI 1.04–2.63) and SRAE (OR 2.33, 95% CI 1.46–3.71), and decreasing FB was significantly associated with decreased MAKE (OR 0.46, 95% CI 0.29–0.79) after adjustment for potential covariates.ConclusionLatent subgroups of septic patients followed a similar FB progression. These latent fluid trajectories were associated with clinical outcomes. The decreasing FB trajectory was associated with a decreased risk of hospital mortality and MAKE.
Highlights
Septic shock has a high incidence and mortality rate in Intensive Care Units (ICUs)
In adjusting for potential confounders, we found that compared with low fluid balance (FB), high FB was significantly associated with increased hospital mortality (HR 1.63, 95% confidence interval (CI) 1.22– 2.17), organ dysfunction, major adverse kidney events (MAKE) and severe respiratory adverse events (SRAE), and decreasing FB was associated with lower risk of MAKE
Using multivariable Cox or logistic regression analysis, we found that compared with the low FB group, the high FB group showed an association with an increased risk of hospital mortality, organ dysfunction, MAKE and Clinical outcome Events [n (%)] Adjusted hazard ratio (HR)/odds ratio (OR) P
Summary
Septic shock has a high incidence and mortality rate in Intensive Care Units (ICUs). Earlier intravenous fluid resuscitation can significantly improve outcomes in septic patients but leads to fluid overload (FO), which is associated with poor clinical outcomes. Intensive care medicine is well advanced, severe sepsis and septic shock have a high prevalence and mortality rate [2, 3]. International guidelines and studies support earlier intravenous fluid resuscitation for the management of sepsis or septic shock [1, 6]. Critically ill patients seem to accumulate a positive fluid balance (FB) or fluid overload (FO) [7,8,9,10], and studies have demonstrated that a more aggressive course of fluid resuscitation is associated with adverse outcomes in critically ill subjects [8, 11]
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