Interaction between fluid balance and disease severity on patient outcome in the critically ill

Shum, Hoi‐Ping; Lee, Frank Man Hon; Chan, Kenny K C; Yan, Wing Wa

doi:10.1016/j.jcrc.2011.02.008

Cited by 39 publications

(29 citation statements)

References 18 publications

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“…However, the total amount of fluids given and the positive fluid balance throughout the intensive care unit stay may be associated with morbidity and mortality. In fact, early positive fluid balance (first 24 h) may be associated with improved survival, whereas later on in the critical illness course, positive fluid balance may correlate with mortality [6]. These findings are in line with the "golden hour" concept in trauma and with the recently published "four phases" model of fluid resuscitation [7].…”

supporting

confidence: 75%

Is the literature inconclusive about the harm from HES? Yes

2016

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supporting

confidence: 75%

Is the literature inconclusive about the harm from HES? Yes

2016

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“…Fluid therapy in septic shock consists of initial fluid resuscitation followed by conservative fluid management and regulation (29–32). The inflammatory cascade of sepsis is thought to disrupt the endothelial surface, alter the microvascular system, and cause capillary leakage (33–35).…”

Section: Discussionmentioning

confidence: 99%

Cumulative Fluid Balance and Mortality in Septic Patients With or Without Acute Kidney Injury and Chronic Kidney Disease*

Neyra

Canepa-Escaro³

et al. 2016

Critical Care Medicine

117

105

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Objective Incident acute kidney injury (AKI) and prevalent chronic kidney disease (CKD) are commonly encountered in septic patients. We examined the differential effect of AKI and CKD on the association between cumulative fluid balance (CFB) and hospital mortality in critically ill septic patients. Design Retrospective cohort study. Setting Urban academic medical center ICU. Patients ICU adult patients with severe sepsis or septic shock and serum creatinine measured within 3 months prior to and 72 h of ICU admission. Patients with estimated glomerular filtration rate <15 mL/min/1.73m2 or receiving chronic dialysis were excluded. Interventions None. Measurements and Main Results 2632 patients, 1211 with CKD, were followed until hospital death or discharge. AKI occurred in 1525 (57.9%), of whom 679 (44.5%) had CKD. Hospital mortality occurred in 603 (22.9%) patients. Every 1 L increase in CFB at 72 h of ICU admission was independently associated with hospital mortality in all patients, adjusted odds ratio (aOR) 1.06, 95% CI (1.04–1.08), p <0.001, and in each AKI/CKD subgroup: aOR 1.06 (1.03–1.09) for AKI+/CKD+; 1.09 (1.05–1.13) for AKI−/CKD+; 1.05 (1.03–1.08) for AKI+/CKD−; and 1.07 (1.02–1.11) for AKI−/CKD−. There was a significant interaction between AKI and CKD on CFB, p =0.005, such that different CFB cut-offs with the best prognostic accuracy for hospital mortality were identified: 5.9 L for AKI+/CKD+; 3.8 L for AKI−/CKD+; 4.3 L for AKI+/CKD−; and 1.5 L for AKI−/CKD−. The addition of CFB to the admission SOFA score had increased prognostic utility for hospital mortality when compared to SOFA alone, particularly in patients with AKI. Conclusions Higher CFB at 72 h of ICU admission was independently associated with hospital mortality regardless of AKI or CKD presence. We characterized CFB cut-offs associated with hospital mortality based on AKI/CKD status, underpinning the heterogeneity of fluid regulation in sepsis and kidney disease.

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“…In many studies, adequate early fluid resuscitation during the initial few hours after the recognition of shock has been associated with a decrease in mortality [35][36][37][38]. In a multicenter trial involving adult patients with septic shock, mortality was lower when at least 1 L of fluid was administered during the first hour after onset of hypotension followed by vasopressor initiation between 1 and 6 h post-hypotension onset [36].…”

Section: Discussionmentioning

confidence: 99%