Impact of a cumulative positive fluid balance during the first three ICU days in patients with sepsis : a propensity score-matched cohort study
© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Annals of intensive care - 13(2023), 1 vom: 19. Okt., Seite 105 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hyun, Dong-Gon [VerfasserIn] |
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| Links: |
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| Themen: |
Fluid therapy |
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| Anmerkungen: |
Date Revised 18.11.2023 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1186/s13613-023-01178-x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM363457305 |
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| 100 | 1 | |a Hyun, Dong-Gon |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impact of a cumulative positive fluid balance during the first three ICU days in patients with sepsis |b a propensity score-matched cohort study |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Revised 18.11.2023 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF). | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Fluid therapy | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Resuscitation | |
| 650 | 4 | |a Sepsis | |
| 650 | 4 | |a Septic shock | |
| 700 | 1 | |a Ahn, Jee Hwan |e verfasserin |4 aut | |
| 700 | 1 | |a Huh, Jin Won |e verfasserin |4 aut | |
| 700 | 1 | |a Hong, Sang-Bum |e verfasserin |4 aut | |
| 700 | 1 | |a Koh, Younsuck |e verfasserin |4 aut | |
| 700 | 1 | |a Oh, Dong Kyu |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Su Yeon |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Mi Hyeon |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Haein |e verfasserin |4 aut | |
| 700 | 1 | |a Lim, Chae-Man |e verfasserin |4 aut | |
| 700 | 0 | |a Korean Sepsis Alliance (KSA) Investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Oh, Dong Kyu |e investigator |4 oth | |
| 700 | 1 | |a Suh, Gee Young |e investigator |4 oth | |
| 700 | 1 | |a Jeon, Kyeongman |e investigator |4 oth | |
| 700 | 1 | |a Ko, Ryoung-Eun |e investigator |4 oth | |
| 700 | 1 | |a Cho, Young-Jae |e investigator |4 oth | |
| 700 | 1 | |a Lee, Yeon Joo |e investigator |4 oth | |
| 700 | 1 | |a Lim, Sung Yoon |e investigator |4 oth | |
| 700 | 1 | |a Park, Sunghoon |e investigator |4 oth | |
| 700 | 1 | |a Heo, Jeongwon |e investigator |4 oth | |
| 700 | 1 | |a Lee, Jae-Myeong |e investigator |4 oth | |
| 700 | 1 | |a Kim, Kyung Chan |e investigator |4 oth | |
| 700 | 1 | |a Lee, Yeon Joo |e investigator |4 oth | |
| 700 | 1 | |a Chang, Youjin |e investigator |4 oth | |
| 700 | 1 | |a Jeon, Kyeongman |e investigator |4 oth | |
| 700 | 1 | |a Lee, Sang-Min |e investigator |4 oth | |
| 700 | 1 | |a Hong, Suk-Kyung |e investigator |4 oth | |
| 700 | 1 | |a Cho, Woo Hyun |e investigator |4 oth | |
| 700 | 1 | |a Kwak, Sang Hyun |e investigator |4 oth | |
| 700 | 1 | |a Lee, Heung Bum |e investigator |4 oth | |
| 700 | 1 | |a Ahn, Jong-Joon |e investigator |4 oth | |
| 700 | 1 | |a Seong, Gil Myeong |e investigator |4 oth | |
| 700 | 1 | |a Lee, Song-I |e investigator |4 oth | |
| 700 | 1 | |a Park, Sunghoon |e investigator |4 oth | |
| 700 | 1 | |a Park, Tai Sun |e investigator |4 oth | |
| 700 | 1 | |a Lee, Su Hwan |e investigator |4 oth | |
| 700 | 1 | |a Choi, Eun Young |e investigator |4 oth | |
| 700 | 1 | |a Moon, Jae Young |e investigator |4 oth | |
| 700 | 1 | |a Kang, Hyung Koo |e investigator |4 oth | |
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