The Effect of Initial Volume Resuscitation for Sepsis in Patients with Congestive Heart Failure: Is it Associated with Higher Mortality

Singh, Harsimar; Iskandir, Marina; Sachdev, Sarina; Simmons, Bonnie; Rabines, Alfredo; Hassen, Getaw Worku

doi:10.1016/j.cardfail.2016.06.161

Cited by 8 publications

(9 citation statements)

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“…The 2016 Surviving Sepsis Campaign guideline issued a recommendation for using a minimum of 30 mL/kg (ideal body weight) of intravenous crystalloids in initial fluid resuscitation (2). Previous studies on fluid management in patients with sepsis with HF have mainly focused on this bundle implementation (24)(25)(26). Most sepsis patients require continued fluid administration following initial resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study

Dong

Gao

et al. 2022

Front. Med.

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Sepsis management includes intravenous fluid (IVF) resuscitation, but patients with pre-existing congestive heart failure (CHF) have a higher risk of fluid overload. Further, patients with sepsis with concomitant CHF present worse clinical outcomes. Nevertheless, there is limited evidence of the association between fluid management and the outcomes of patients with concomitant sepsis and CHF. This retrospective cohort study aimed to evaluate the association between fluid management and in-hospital mortality in patients with sepsis and concomitant heart failure (HF). The patients' data were extracted from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. The primary outcome was in-hospital mortality. A restricted cubic spline model was used to explore the relationship between variables and in-hospital mortality. Logistic models were built using the linear spline function and design variables to investigate the association of fluid balance (FB), fluid intake (FI), and fluid accumulation index (FAI, calculated as the FB/FI ratio) with mortality. Overall, 1,801 patients were included. The overall mortality rate was 27.7%. After adjusting for confounding variables, FAI was found to be associated with in-hospital mortality, whereas FB and FI were not. With FAI values of 0–0.42 set as references, FAI values <0 were not associated with in-hospital mortality [odds ratio (OR): 1.078; 95% confidence interval (CI): 0.774–1.503], whereas FAI values > 0.42 were significantly associated with higher in-hospital mortality (OR: 1.461; 95% CI: 1.099–1.954). High FAI values (>0.42) were associated with high in-hospital mortality in patients with sepsis with HF, while FB and FI were not. Proper fluid management may improve the outcomes of patients with sepsis and concomitant HF.

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Section: Discussionmentioning

confidence: 99%

Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study

Dong

Gao

et al. 2022

Front. Med.

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“…8 Clinicians are particularly concerned about the potential harms of empirical fluid administration to patients with underlying heart failure with reduced ejection fraction (HFrEF), who may be at higher risk of complications. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 A greater understanding of the epidemiology of preexisting HFrEF prior to sepsis and its association with outcomes is needed to balance the pros and cons of fluid resuscitation for these patients at high risk. To address these knowledge gaps, in a multicenter cohort study, we explored the epidemiology of HFrEF diagnosed prior to hospitalization for sepsis and its risk-adjusted association with guideline-recommended intravenous fluid administration and outcome during emergency care of septic shock.…”

Section: Introductionmentioning

confidence: 99%

Association Between Preexisting Heart Failure With Reduced Ejection Fraction and Fluid Administration Among Patients With Sepsis

et al. 2022

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ImportanceIntravenous fluid administration is recommended to improve outcomes for patients with septic shock. However, there are few data on fluid administration for patients with preexisting heart failure with reduced ejection fraction (HFrEF).ObjectiveTo evaluate the association between preexisting HFrEF, guideline-recommended intravenous fluid resuscitation, and mortality among patients with community-acquired sepsis and septic shock.Design, Setting, and ParticipantsA cohort study was conducted of adult patients hospitalized in an integrated health care system from January 1, 2013, to December 31, 2015, with community-acquired sepsis and preexisting assessment of cardiac function. Follow-up occurred through July 1, 2016. Data analyses were performed from November 1, 2020, to August 8, 2022.ExposuresPreexisting heart failure with reduced ejection fraction (≤40%) measured by transthoracic echocardiogram within 1 year prior to hospitalization for sepsis.Main Outcomes and MeasuresMultivariable models were adjusted for patient factors and sepsis severity and clustered at the hospital level to generate adjusted odds ratios (aORs) and 95% CIs. The primary outcome was the administration of 30 mL/kg of intravenous fluid within 6 hours of sepsis onset. Secondary outcomes included in-hospital mortality, intensive care unit admission, rate of invasive mechanical ventilation, and administration of vasoactive medications.ResultsOf 5278 patients with sepsis (2673 men [51%]; median age, 70 years [IQR, 60-81 years]; 4349 White patients [82%]; median Sequential Organ Failure Assessment score, 4 [IQR, 3-5]), 884 (17%) had preexisting HFrEF, and 2291 (43%) met criteria for septic shock. Patients with septic shock and HFrEF were less likely to receive guideline-recommended intravenous fluid than those with septic shock without HFrEF (96 of 380 [25%] vs 699 of 1911 [37%]; P &lt; .001), but in-hospital mortality was similar (47 of 380 [12%] vs 244 of 1911 [13%]; P = .83). In multivariable models, HFrEF was associated with a decreased risk-adjusted odds of receiving 30 mL/kg of intravenous fluid within the first 6 hours of sepsis onset (aOR, 0.63; 95% CI, 0.47-0.85; P = .002). The risk-adjusted mortality was not significantly different among patients with HFrEF (aOR, 0.92; 95% CI, 0.69-1.24; P = .59) compared with those without, and there was no interaction with intravenous fluid volume (aOR, 1.00; 95% CI, 0.98-1.03; P = .72).Conclusions and RelevanceThe results of this cohort study of patients with community-acquired septic shock suggest that preexisting HFrEF was common and was associated with reduced odds of receiving guideline-recommended intravenous fluids.

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“…In a published scientific abstract (full length manuscript not published), Singh et al studied the effect of initial volume resuscitation for sepsis in patients with CHF (left ventricular ejection fraction <40%). 16 Of a total of 505 patients included in the study for sepsis, 151 had low ejection fraction. The authors found higher in-hospital mortality in septic patients with low EF, who received >3 L initial fluids.…”

Section: Discussionmentioning

confidence: 99%

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

Vindhyal

Ranka

et al. 2021

J Intensive Care Med

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Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

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The Effect of Initial Volume Resuscitation for Sepsis in Patients with Congestive Heart Failure: Is it Associated with Higher Mortality

Cited by 8 publications

References 0 publications

Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study

Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study

Association Between Preexisting Heart Failure With Reduced Ejection Fraction and Fluid Administration Among Patients With Sepsis

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

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