Time-related association between fluid balance and mortality in sepsis patients: interaction between fluid balance and haemodynamics

Yanfei Shen,Weimin Zhang,Weizhe Ru,Xinmei Huang

doi:10.1038/s41598-018-28781-4

Yanfei Shen, Weimin Zhang + Show 2 more

Open Access

https://doi.org/10.1038/s41598-018-28781-4

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Journal: Scientific Reports	Publication Date: Jul 10, 2018
Citations: 16	License type: open-access

Affiliation: Zhejiang Hospital, Cixian People's Hospital

Abstract

This study aimed to investigate the time-related association between cumulative fluid balance (FB) and mortality. Data were extracted from the Medical Information Mart for Intensive Care (MIMIC) III. FB data on 8584 patients at the first (FB-fir24hr) and second (FB-sec24hr) 24 hours after intensive care unit admission were analysed. Compared to the combination of FB-fir24hr ≤ 0 and FB-sec24 hr ≤ 0, the combination of FB-fir24hr > 0 and FB-sec24hr ≤ 0 had significantly higher FB, with an insignificant odds ratio (OR) for mortality. However, the mortality ORs of two other combinations (FB-fir24hr ≤ 0 and FB-sec24hr > 0; FB-fir24hr > 0 and FB-sec24hr > 0) were significantly high. Furthermore, multivariable logistic analysis showed a significant stepwise increase ORs for mortality with increasing FB-sec24hr quartiles, with no significant increase in FB-fir24hr quartiles aside from quartile 4. In patients with negative FB, a stepwise decrease in mortality ORs with increasing FB-sec24hr quartiles was found with no significant difference in FB-fir24hr quartiles. In conclusion, the positive FB during the second but not the first 24 hours was associated with increased mortality in sepsis. Achieving more negative FB was associated with decreased mortality only in the second 24 hours.

Highlights

Fluid management is critically important in the initial stages of sepsis resuscitation
We hypothesized that there was an interaction between early fluid balance (FB) and haemodynamic status that contributed to the insignificant association between positive FB-fir24hr and mortality
The post-hoc analysis in Vasopressin and Septic Shock Trial (VASST) showed that cumulative positive FB over four days was associated with higher mortality in septic shock[8], while Micek et al found the highest positive FB quartile at eight days was an independent predictor of hospital mortality[9]

Summary

Introduction

Fluid management is critically important in the initial stages of sepsis resuscitation. Micek et al reported that the highest quartile of positive FB at eight days was an independent predictor of hospital mortality[9]. Consistent with these findings, another observational study[10] found that the accumulated positive FB in the first 48, 72, and 96 hours was associated with higher mortality in sepsis. In patients with unstable haemodynamics, the detrimental effect of positive FB may be overwhelmed by the benefit of adequate fluid resuscitation, leading to an insignificant association. We speculated that a possible interaction between FB and haemodynamic status could lead to the disputed conclusions regarding the association between early positive FB and sepsis-related mortality

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