Higher Fluid Balance Increases the Risk of Death From Sepsis: Results From a Large International Audit

Yasser Sakr, Paolo Nahuel Rubatto Birri, Katarzyna Kotfis, Rahul Nanchal, Bhagyesh Shah, Stefan Kluge, Mary E Schroeder, John C. Marshall, Jean Louis Vincent, Intensive Care Over Nations Investigators, Pasquale De Negri, Erminio Sisillo

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Abstract

OBJECTIVES: Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis.DESIGN: Observational cohort study.SETTING: Seven hundred and thirty ICUs in 84 countries.PATIENTS: All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission.MEASUREMENTS AND MAIN RESULTS: ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock.CONCLUSIONS: In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death.
Original languageUndefined/Unknown
Pages (from-to)386-394
Number of pages9
JournalCritical Care Medicine
Volume45
Issue number3
DOIs
Publication statusPublished - Mar 1 2017

Keywords

  • Journal Article

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Higher Fluid Balance Increases the Risk of Death From Sepsis: Results From a Large International Audit. / Sakr, Yasser; Rubatto Birri, Paolo Nahuel; Kotfis, Katarzyna; Nanchal, Rahul; Shah, Bhagyesh; Kluge, Stefan; Schroeder, Mary E; Marshall, John C.; Vincent, Jean Louis; Investigators, Intensive Care Over Nations; De Negri, Pasquale; Sisillo, Erminio.

In: Critical Care Medicine, Vol. 45, No. 3, 01.03.2017, p. 386-394.

Research output: Contribution to journalArticle

Sakr, Y, Rubatto Birri, PN, Kotfis, K, Nanchal, R, Shah, B, Kluge, S, Schroeder, ME, Marshall, JC, Vincent, JL, Investigators, ICON, De Negri, P & Sisillo, E 2017, 'Higher Fluid Balance Increases the Risk of Death From Sepsis: Results From a Large International Audit', Critical Care Medicine, vol. 45, no. 3, pp. 386-394. https://doi.org/10.1097/CCM.0000000000002189
Sakr, Yasser ; Rubatto Birri, Paolo Nahuel ; Kotfis, Katarzyna ; Nanchal, Rahul ; Shah, Bhagyesh ; Kluge, Stefan ; Schroeder, Mary E ; Marshall, John C. ; Vincent, Jean Louis ; Investigators, Intensive Care Over Nations ; De Negri, Pasquale ; Sisillo, Erminio. / Higher Fluid Balance Increases the Risk of Death From Sepsis: Results From a Large International Audit. In: Critical Care Medicine. 2017 ; Vol. 45, No. 3. pp. 386-394.
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T1 - Higher Fluid Balance Increases the Risk of Death From Sepsis: Results From a Large International Audit

AU - Sakr, Yasser

AU - Rubatto Birri, Paolo Nahuel

AU - Kotfis, Katarzyna

AU - Nanchal, Rahul

AU - Shah, Bhagyesh

AU - Kluge, Stefan

AU - Schroeder, Mary E

AU - Marshall, John C.

AU - Vincent, Jean Louis

AU - Investigators, Intensive Care Over Nations

AU - De Negri, Pasquale

AU - Sisillo, Erminio

PY - 2017/3/1

Y1 - 2017/3/1

N2 - OBJECTIVES: Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis.DESIGN: Observational cohort study.SETTING: Seven hundred and thirty ICUs in 84 countries.PATIENTS: All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission.MEASUREMENTS AND MAIN RESULTS: ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock.CONCLUSIONS: In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death.

AB - OBJECTIVES: Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis.DESIGN: Observational cohort study.SETTING: Seven hundred and thirty ICUs in 84 countries.PATIENTS: All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission.MEASUREMENTS AND MAIN RESULTS: ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock.CONCLUSIONS: In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death.

KW - Journal Article

U2 - 10.1097/CCM.0000000000002189

DO - 10.1097/CCM.0000000000002189

M3 - Articolo

VL - 45

SP - 386

EP - 394

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 3

ER -