Relation between fluid overload and mortality in children with septic shock

Márquez-González, Horacio; Casanova-Bracamontes, Luis; Muñoz-Ramírez, C Mireya; Peregrino-Bejarano, Leoncio; Bolaños-Téllez, Bárbara; Yáñez-Gutiérrez, Lucelli

doi:10.5546/aap.2019.eng.105

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…We showed that fluid overload of > 10% was an independent predictor of pediatric sepsis mortality. This result was similar to a previous study with a study setting in a middle-resource country which showed that fluid overload percentage of > 10.1% in the first 96 h of sepsis patient care was associated with higher mortality in the first 28 days of care [ 13 ]. Moreover, this condition can be explained by the integration of the renal hemodynamic and physiological systems.…”

Section: Discussionsupporting

confidence: 91%

Factors associated with mortality of pediatric sepsis patients at the pediatric intensive care unit in a low-resource setting

et al. 2021

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Background Sepsis is the leading cause of death worldwide in pediatric populations. Studies in low-resource settings showed that the majority of pediatric patients with sepsis still have a high mortality rate. Methods We retrospectively collected records from 2014 to 2019 of patients who had been diagnosed with sepsis and admitted to PICU in our tertiary hospital. Cox proportional hazard regression modeling was used to evaluate associations between patient characteristics and mortality. Results Overall, 665 patients were enrolled in this study, with 364 (54.7%) boys and 301 (46.3%) girls. As many as 385 patients (57.9%) died during the study period. The median age of patients admitted to PICU were 1.8 years old with interquartile range (IQR) ±8.36 years and the median length of stay was 144 h (1–1896 h). More than half 391 patients (58.8%) had a good nutritional status. Higher risk of mortality in PICU was associated fluid overload percentage of > 10% (HR 9.6, 95% CI: 7.4–12.6), the need of mechanical ventilation support (HR 2.7, 95% CI: 1.6–4.6), vasoactive drugs (HR 1.5, 95% CI: 1.2–2.0) and the presence of congenital anomaly (HR 1.4, 95% CI: 1.0–1.9). On the contrary, cerebral palsy (HR 0.3, 95% CI: 0.1–0.5) and post-operative patients (HR 0.4, 95% CI: 0.3–0.6) had lower mortality. Conclusion PICU mortality in pediatric patients with sepsis is associated with fluid overload percentage of > 10%, the need for mechanical ventilation support, the need of vasoactive drugs, and the presence of congenital anomaly. In septic patients in PICU, those with cerebral palsy and admitted for post-operative care had better survival.

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Section: Discussionsupporting

confidence: 91%

Factors associated with mortality of pediatric sepsis patients at the pediatric intensive care unit in a low-resource setting

et al. 2021

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“…Our previous study considered FO to be a fluid accumulation (L) greater than 10% of initial body weight (kg), which is associated with the occurrence of AKI and increases the severity of AKI [ 13 ]. FO is also a major predictor of poor clinical outcomes [ 12 , 40 – 43 ]. A retrospective study showed that FO (≥ 10% L/kg) prolonged multiorgan failure based on the sub-SOFA score of the kidney in septic shock patients and increased 90-d mortality [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Association of fluid balance trajectories with clinical outcomes in patients with septic shock: a prospective multicenter cohort study

et al. 2021

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Background 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 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. Methods Patients 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. Results Nine 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. Conclusion Latent 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.

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“…For example, the authors did not have data on the amount of crystalloid administered prior to or after the initiation of vasoactive drugs, a factor that is known to have an impact on outcomes. 19 Additionally, although the present sample was satisfactory to evaluate and compare the two groups (with and without CCC), it does not provide us with the possibility of making comparisons between the subgroups due to the small sample size in each CCC category. Despite being a great result, the low mortality in the “without CCC” group (6 deaths) does not allow the predictive power for mortality of the VIS and PELOD-2 scores to be compared with due accuracy between the groups “CCC” and “without CCC”.…”

Section: Discussionmentioning

confidence: 87%

Epidemiology and outcomes of septic shock in children with complex chronic conditions in a developing country PICU

Rech¹,

Sousa²,

Tonial³

et al. 2022

Jornal de Pediatria

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Relation between fluid overload and mortality in children with septic shock

Cited by 7 publications

References 20 publications

Factors associated with mortality of pediatric sepsis patients at the pediatric intensive care unit in a low-resource setting

Factors associated with mortality of pediatric sepsis patients at the pediatric intensive care unit in a low-resource setting

Association of fluid balance trajectories with clinical outcomes in patients with septic shock: a prospective multicenter cohort study

Epidemiology and outcomes of septic shock in children with complex chronic conditions in a developing country PICU

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