Positive fluid balance as a major predictor of clinical outcome of patients with sepsis/septic shock after ICU discharge

Evgeni Brotfain, Leonid Koyfman, Ronen Toledano, Abraham Borer, Lior Fucs, Ori Galante, Amit Frenkel, Ruslan Kutz, Moti Klein

Research output: Contribution to journalArticlepeer-review

53 Scopus citations

Abstract

Introduction Sepsis and septic shock continue to be syndromes that carry a high mortality rate worldwide. Early aggressive fluid and vasopressor support have resulted in significant improvement in patient outcomes. The prognostic clinical significance of a positive fluid balance in septic intensive care unit (ICU) patients remains undetermined. Methods We collected data from 297 septic patients hospitalized in our general and medical ICUs at Soroka Medical Center between January 2005 and June 2011 and divided the 4 study groups into the following 4 fluid balances: group 1, patients with fluid balance at discharge from ICU (FBD) less than 10 L; group 2, patients with an FBD of 10 to 20 L; group 3, patients with an FBD of 20 to 30 L; and group 4, patients with FBD in excess of 30 L. Results The ICU and in-hospital mortality rate was also significantly higher in groups 2 to 4 as compared with group 1 (P <.001 for both ICU and in-hospital mortality). The positive cumulative FBD was found to be an independent predictor of ICU mortality (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06; P <.001; Table 3) and in-hospital mortality (OR, 1.06; 95% CI, 1.03-1.08; P <.001; Table 5) and also to constitute a risk factor for new organ system dysfunction at hospital discharge (OR, 1.01; 95% CI, 1.01-1.013; P <.001; Table 6) in critically ill patients with severe sepsis/septic shock. Conclusions Although it is a monocentric retrospective study, we suggest that positive cumulative fluid balance is one of the major factors that can predict the clinical outcome of critically ill patients during their ICU stay and after their discharge from the ICU.

Original languageEnglish
Pages (from-to)2122-2126
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume34
Issue number11
DOIs
StatePublished - 1 Nov 2016

ASJC Scopus subject areas

  • Emergency Medicine

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