Impact of a cumulative positive fluid balance during the first three ICU days in patients with sepsis: a propensity score-matched cohort study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

The optimal strategy for fluid management during the first few days of ICU in sepsis patients remains controversial. We aimed to investigate the impact of cumulative fluid balance during the first three days of ICU on the mortality of patients with sepsis.

Methods

This study analyzed prospectively collected data from the Korean Sepsis Alliance Database, which registered 11,981 sepsis patients from 20 hospitals. We selected three propensity score-matched cohorts consisting of patients with a negative or positive cumulative fluid balance during the first three ICU days: from ICU admission to the first midnight as the D1 cohort, until the second midnight as the D2 cohort, and until the third midnight as the D3 cohort. The propensity score for fluid balance was calculated using covariates including the amount of fluid output during the first three ICU days. The primary outcome was mortality at day 28 in the ICU.

Results

From a total of 11,981 patients, 2516 patients were included for propensity score matching. After matching in a 1:1 ratio, there were 483, 373, and 392 matched pairs of patients assigned to the D1, D2, and D3 cohorts, respectively. In the D1 cohort, there were no significant differences in mortality at day 28 (hazard ratio [HR], 1.17; 95% confidence interval [CI] 0.85–1.60; P = 0.354) between the two groups. The positive fluid groups in both the D2 (HR, 2.13; 95% CI 1.48–3.06; P < 0.001) and D3 (HR, 1.56; 95% CI 1.10–2.22; P = 0.012) cohorts had significantly higher mortality rates than the negative fluid groups.

Conclusions

In patients with sepsis, a positive fluid balance on the first ICU day was not associated with mortality at day 28. In contrast, cumulative positive fluid balances on the second and third ICU days were associated with higher mortality at day 28.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-023-01178-x.

Related collections

Most cited references 33

Record: found
Abstract: found
Article: found

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour … (2016)

Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.

0 comments Cited 6327 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

Laura Evans, Andrew Rhodes, Waleed Alhazzani … (2021)

0 comments Cited 976 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Time to Treatment and Mortality during Mandated Emergency Care for Sepsis.

Christopher W Seymour, Foster C Gesten, Hallie C Prescott … (2017)

Background In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. Methods We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3-hour bundle of care for patients with sepsis (i.e., blood cultures, broad-spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3-hour bundle and risk-adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. Results Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3-hour bundle completed within 3 hours. The median time to completion of the 3-hour bundle was 1.30 hours (interquartile range, 0.65 to 2.35), the median time to the administration of antibiotics was 0.95 hours (interquartile range, 0.35 to 1.95), and the median time to completion of the fluid bolus was 2.56 hours (interquartile range, 1.33 to 4.20). Among patients who had the 3-hour bundle completed within 12 hours, a longer time to the completion of the bundle was associated with higher risk-adjusted in-hospital mortality (odds ratio, 1.04 per hour; 95% confidence interval [CI], 1.02 to 1.05; P<0.001), as was a longer time to the administration of antibiotics (odds ratio, 1.04 per hour; 95% CI, 1.03 to 1.06; P<0.001) but not a longer time to the completion of a bolus of intravenous fluids (odds ratio, 1.01 per hour; 95% CI, 0.99 to 1.02; P=0.21). Conclusions More rapid completion of a 3-hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk-adjusted in-hospital mortality. (Funded by the National Institutes of Health and others.).

0 comments Cited 699 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Chae-Man Lim:

ORCID: http://orcid.org/0000-0001-5400-6588

cmlim@amc.seoul.kr

Journal

Journal ID (nlm-ta): Ann Intensive Care

Journal ID (iso-abbrev): Ann Intensive Care

Title: Annals of Intensive Care

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2110-5820

Publication date (Electronic): 19 October 2023

Publication date PMC-release: 19 October 2023

Publication date Collection: 2023

Volume: 13

Electronic Location Identifier: 105

Affiliations

[1 ]GRID grid.267370.7, ISNI 0000 0004 0533 4667, Department of Pulmonary and Critical Care Medicine, Asan Medical Center, , University of Ulsan College of Medicine, ; 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea

[2 ]Samsung medical center, ( https://ror.org/05a15z872) seoul, South Korea

[3 ]Seoul National University Bundang Hospital, ( https://ror.org/00cb3km46) seongnam, South Korea

[4 ]Hallym University Sacred Heart Hospital, ( https://ror.org/04ngysf93) Anyang, South Korea

[5 ]Kangwon national university hospital, ( https://ror.org/01rf1rj96) Gangneung, South Korea

[6 ]GRID grid.411134.2, ISNI 0000 0004 0474 0479, Korea University Anam Hospital, ; Seoul, South Korea

[7 ]Daegu Catholic University Hospital, Daegu, South Korea

[8 ]Inje University Sanggye Paik Hospital, ( https://ror.org/027j9rp38) Seoul, South Korea

[9 ]Seoul National University Hospital, ( https://ror.org/01z4nnt86) Seoul, South Korea

[10 ]Pusan National University Yangsan Hospital, ( https://ror.org/04kgg1090) Pusan, South Korea

[11 ]Chonnam National University Hospital, ( https://ror.org/00f200z37) Gwangju, South Korea

[12 ]Jeonbuk National University Hospital, ( https://ror.org/05q92br09) Jeonju, South Korea

[13 ]Ulsan University Hospital, ( https://ror.org/03sab2a45) Ulsan, South Korea

[14 ]Jeju National University Hospital, ( https://ror.org/05p64mb74) Jeju, South Korea

[15 ]Chungnam National University Hospital, ( https://ror.org/04353mq94) Daejeon, South Korea

[16 ]Hanyang University Guri Hospital, ( https://ror.org/02f9avj37) Guri, South Korea

[17 ]Severance Hospital, ( https://ror.org/044kjp413) Seoul, South Korea

[18 ]Yeungnam University Medical Center, ( https://ror.org/04ntyjt11) Daegu, South Korea

[19 ]Chungnam National University Sejong Hospital, ( https://ror.org/0227as991) Sejong, South Korea

[20 ]Inje University Ilsan Paik Hospital, ( https://ror.org/01zx5ww52) Ilsan, South Korea

Author information

Chae-Man Lim http://orcid.org/0000-0001-5400-6588

Article

Publisher ID: 1178

DOI: 10.1186/s13613-023-01178-x

PMC ID: 10584773

PubMed ID: 37853234

SO-VID: 25e5d02f-c0a3-4916-9ada-6ed9546db588

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 15 January 2023

Date accepted : 24 August 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003669, Korea Centers for Disease Control and Prevention;

Award ID: 2019E280500

Award ID: 2020E280700

Award ID: 2021-10-026

Award Recipient : Chae-Man Lim

Custom metadata

issue-copyright-statement © La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF) 2023

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: sepsis,septic shock,resuscitation,mortality,fluid therapy

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: sepsis, septic shock, resuscitation, mortality, fluid therapy

Comments

Comment on this article

scite_

Cited by 2

See all cited by

Impact of a cumulative positive fluid balance during the first three ICU days in patients with sepsis: a propensity score-matched cohort study

Read this article at

Abstract

Background

Methods

Results

Conclusions

Supplementary Information

Related collections

Irish Journal of Paramedicine

Most cited references 33

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

Time to Treatment and Mortality during Mandated Emergency Care for Sepsis.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 226

Cited by 2