HEMODILUTION: INCIDENCE, PRECIPITATING FACTORS AND AN INDEPENDENT MARKER OF PROGNOSIS IN THE CRITICALLY ILL

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Many patients admitted to the ICU require aggressive crystalloid fluid administration. It has been shown previously that hemoglobin concentrations typically decline more than 0.5 g/dl/day during the first few days of ICU stay in non-bleeding patients. However the relationship between fluid administration and development of hemodilution in ICU patients has not previously been studied. We studied the relationship between fluid administration and development of hemodilution. And studied the impact of this hemodilution on survival of critically ill patients in the ICU. METHODS: A retrospective observational study on 75 patients admitted to the ICU was designed. Daily hemoglobin levels and fluid balance were collected in patients admitted to the ICU. Patients with any gross bleeding were excluded. Those administered greater than 2 liters of 0.9% normal saline intravenous fluid (IVF) were categorized as aggressive fluid strategy group (AFSG), while those administered less than 2 liters of IVF were categorized as conservative fluid strategy group (CFSG). The change in hemoglobin at 24, 48, and 72 hours between the two groups were compared. Furthermore, the septic shock AFSG (N=16) was sub-analyzed and the decrease in their hemoglobin at 24, 48, and 72 hours were compared between those who survived and those who died with septic shock. RESULTS: The difference in hemodilution between the AFSG and CFSG was statistically significant (P <0.05) at 48 and 72 hours only and not at 24 hours. The average hemodilution in the AFSG was 2.64 ± 1.62 g/dl and 3.27 ± 2.08 g/dl at 48 and 72 hours respectively. In the sub-group analysis, septic shock patients who survived showed statistically significant hemodilution of 4.23 ±2.32 g/dl at 72 hours when compared to hemodilution in septic shock patients who died (P <0.05). CONCLUSIONS: There is hemodilution with the AFSG occurring at 48 and 72 hours only but not at 24 hours. In septic shock AFSG, the surviving patients showed greater hemodilution than those who died at 72 hours in the ICU. CLINICAL IMPLICATIONS: Our study demonstrated the association of hemodilution after 48 and 72 hrs in our aggressively fluid resuscitated critically ill patients. Hence, any decrease in hemoglobin during their illness can be associated to fluid resuscitation and not necessarily acute blood loss. This in turn may help minimize blood transfusions in critically ill anemic patients without any gross bleeding. Additionally, septic shock patients who survived in AFSG, showed hemodilution at 72 hrs indicating utility of hemodilution as a prognostic marker. Perhaps surviving patients have a preserved microcirculation due to less inflammation and therefore are able to attain their fluids intravascularly leading to hemodilution. This marker can be further studied to help prognosticate patients with septic shock and even allocate certain therapies aimed at controlling inflammation in our septic patients. DISCLOSURES: No relevant relationships by Jalal Damani, source=Web Response