Impact of Early Fluid Balance on Long-Term Mortality in Critically Ill Surgical Patients: A Retrospective Cohort Study in Central Taiwan.

Chieh-Liang Wu,Li-Ting Wong,Kai-Chih Pai,Min-Shian Wang,Wen-Cheng Chao

doi:10.3390/jcm10214873

Abstract

Fluid balance is an essential issue in critical care; however, the impact of early fluid balance on the long-term mortality in critically ill surgical patients remains unknown. This study aimed to address the impact of day 1–3 and day 4–7 fluid balance on the long-term mortality in critically ill surgical patients. We enrolled patients who were admitted to surgical intensive care units (ICUs) during 2015–2019 at a tertiary hospital in central Taiwan and retrieved date-of-death from the Taiwanese nationwide death registration profile. We used a Log-rank test and a multivariable Cox proportional hazards regression model to determine the independent mortality impact of early fluid balance. A total of 6978 patients were included for analyses (mean age: 60.9 ± 15.9 years; 63.9% of them were men). In-hospital mortality, 90-day mortality, 1-year and overall mortality was 10.3%, 15.8%, 23.8% and 31.7%, respectively. In a multivariable Cox proportional hazard regression model adjusted for relevant covariates, we found that positive cumulative day 4–7 fluid balance was independently associated with long-term mortality (aHR 1.083, 95% CI 1.062–1.105), and a similar trend was found on day 1–3 fluid balance, although to a lesser extent (aHR 1.027, 95% CI 1.011–1.043). In conclusion, the fluid balance in the first week of ICU stay, particularly day 4–7 fluid balance, may affect the long-term outcome in critically ill surgical patients.

Highlights

In a multivariate Cox proportional hazard regression model adjusted for age, sex, body mass index, Acute Physiology and Chronic Health Evaluation (APACHE) acute physiology and chronic health evaluation (II) score, presence of shock, receiving surgery during intensive care units (ICUs) stay and relevant covariates, we found that positive cumulative day 4–7 fluid balance was independently associated with mortality and a similar trend was found in day 1–3 fluid balance to a lesser extent (Table 3)
We linked databases at Taichung Veterans General Hospital (TCVGH) and Taiwanese National Health Insurance Research Database (NHIRD) to investigate the impact of early fluid balance on long-term mortality in critically ill surgical patients
We found that days 1–3 slightly affected the long-term mortality in critically ill surgical patients with shock

Summary

Introduction

Fluid balance is increasingly recognised as an essential issue in critically ill patients [1,2]; few studies address the long-term mortality impact of early fluid balance, and data in critically ill surgical patients are sparse [3]. A number of studies focusing on early fluid balance identified that conservative acute fluid resuscitation and peri-operative fluid management may affect the short-term outcome [3,10,11]. The enhanced recovery after surgery (ERAS) programme is proposed to improve the outcome of surgical patients; an optimal peri-operative fluid strategy in critically ill surgical patients remains uncertain in ERAS due to distinct surgical risks and the complex patient group [11,12,13]. The optimal fluid strategy after the acute resuscitation and long-term impact on mortality of early fluid balance remains unclear. We used two databases, the critical care database of Taichung

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Discussion

Conclusion