دورية أكاديمية
Associations Between Volume of Early Intravenous Fluid and Hospital Outcomes in Septic Patients With and Without Heart Failure: A Retrospective Cohort Study.
| العنوان: | Associations Between Volume of Early Intravenous Fluid and Hospital Outcomes in Septic Patients With and Without Heart Failure: A Retrospective Cohort Study. |
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| المؤلفون: | Beagle AJ; Department of Medicine, University of California, San Francisco, San Francisco, CA., Prasad PA; Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA., Hubbard CC; Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA., Walderich S; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA., Oreper S; Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA., Abe-Jones Y; Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA., Fang MC; Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA., Kangelaris KN; Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA. |
| المصدر: | Critical care explorations [Crit Care Explor] 2024 Apr 26; Vol. 6 (5), pp. e1082. Date of Electronic Publication: 2024 Apr 26 (Print Publication: 2024). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 101746347 Publication Model: eCollection Cited Medium: Internet ISSN: 2639-8028 (Electronic) Linking ISSN: 26398028 NLM ISO Abbreviation: Crit Care Explor Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Philadelphia, PA : Wolters Kluwer Health, [2019]- |
| مواضيع طبية MeSH: | Heart Failure*/therapy , Heart Failure*/mortality , Fluid Therapy*/methods , Sepsis*/mortality , Sepsis*/therapy, Humans ; Retrospective Studies ; Male ; Female ; Aged ; Middle Aged ; Cohort Studies ; Hospital Mortality ; Intensive Care Units ; Length of Stay |
| مستخلص: | Objectives: To evaluate the relationship between early IV fluid volume and hospital outcomes, including death in-hospital or discharge to hospice, in septic patients with and without heart failure (HF). Design: A retrospective cohort study using logistic regression with restricted cubic splines to assess for nonlinear relationships between fluid volume and outcomes, stratified by HF status and adjusted for propensity to receive a given fluid volume in the first 6 hours. An ICU subgroup analysis was performed. Secondary outcomes of vasopressor use, mechanical ventilation, and length of stay in survivors were assessed. Setting: An urban university-based hospital. Patients: A total of 9613 adult patients were admitted from the emergency department from 2012 to 2021 that met electronic health record-based Sepsis-3 criteria. Preexisting HF diagnosis was identified by the International Classification of Diseases codes. Interventions: None. Measurements and Main Results: There were 1449 admissions from patients with HF. The relationship between fluid volume and death or discharge to hospice was nonlinear in patients without HF, and approximately linear in patients with HF. Receiving 0-15 mL/kg in the first 6 hours was associated with lower likelihood of death or discharge to hospice compared with 30-45 mL/kg (odds ratio = 0.61; 95% CI, 0.41-0.90; p = 0.01) in HF patients, but no significant difference for non-HF patients. A similar pattern was identified in ICU admissions and some secondary outcomes. Volumes larger than 15-30 mL/kg for non-HF patients and 30-45 mL/kg for ICU-admitted non-HF patients were not associated with improved outcomes. Conclusions: Early fluid resuscitation showed distinct patterns of potential harm and benefit between patients with and without HF who met Sepsis-3 criteria. Restricted cubic splines analysis highlighted the importance of considering nonlinear fluid outcomes relationships and identified potential points of diminishing returns (15-30 mL/kg across all patients without HF and 30-45 mL/kg when admitted to the ICU). Receiving less than 15 mL/kg was associated with better outcomes in HF patients, suggesting small volumes may be appropriate in select patients. Future studies may benefit from investigating nonlinear fluid-outcome associations and a focus on other conditions like HF. (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.) |
| References: | Chest. 2020 Feb;157(2):286-292. (PMID: 31622591) JAMA. 2016 Feb 23;315(8):801-10. (PMID: 26903338) JAMA. 2014 Apr 2;311(13):1308-16. (PMID: 24638143) Circulation. 2012 Jul 3;126(1):65-75. (PMID: 22615345) Crit Care Med. 2019 Nov;47(11):1582-1590. (PMID: 31393324) Med Care. 2005 Nov;43(11):1130-9. (PMID: 16224307) Ann Emerg Med. 2016 Sep;68(3):298-311. (PMID: 27085369) Crit Care Med. 2017 Oct;45(10):1596-1606. (PMID: 28671898) JAMA. 2015 Oct 20;314(15):1637-8. (PMID: 26501539) JAMA Netw Open. 2022 Oct 3;5(10):e2235331. (PMID: 36205995) Crit Care. 2013 Oct 20;17(5):R246. (PMID: 24138869) N Engl J Med. 2022 Jun 30;386(26):2459-2470. (PMID: 35709019) Bone Marrow Transplant. 2020 Apr;55(4):675-680. (PMID: 31576022) Crit Care. 2015 Jun 15;19:251. (PMID: 26073560) N Engl J Med. 2023 Feb 9;388(6):499-510. (PMID: 36688507) PLoS One. 2021 Aug 19;16(8):e0256368. (PMID: 34411178) BMJ Open. 2018 Aug 1;8(7):e022185. (PMID: 30068620) PLoS One. 2013 Aug 23;8(8):e72476. (PMID: 24009684) Stat Med. 2010 Apr 30;29(9):1037-57. (PMID: 20087875) Crit Care Med. 2019 Jul;47(7):951-959. (PMID: 30985449) Crit Care Med. 2021 Nov 1;49(11):e1063-e1143. (PMID: 34605781) JAMA. 2017 Oct 3;318(13):1241-1249. (PMID: 28903154) Crit Care. 2020 Jan 28;24(1):25. (PMID: 31992351) N Engl J Med. 2015 Apr 23;372(17):1629-38. (PMID: 25776936) Lancet. 2020 Jan 18;395(10219):200-211. (PMID: 31954465) J Intensive Care Med. 2020 Aug;35(8):810-817. (PMID: 30165769) Crit Care Med. 2020 Feb;48(2):200-209. (PMID: 31939788) Intensive Care Med. 2017 May;43(5):625-632. (PMID: 28130687) Intensive Care Med. 1996 Jul;22(7):707-10. (PMID: 8844239) JAMA. 2014 Jul 2;312(1):90-2. (PMID: 24838355) Mayo Clin Proc Innov Qual Outcomes. 2020 Aug 19;4(5):537-541. (PMID: 33083702) J Thorac Dis. 2020 Feb;12(Suppl 1):S37-S47. (PMID: 32148924) |
| فهرسة مساهمة: | Keywords: fluid therapy; heart failure; intensive care units; regression analysis; sepsis |
| تواريخ الأحداث: | Date Created: 20240502 Date Completed: 20240502 Latest Revision: 20240508 |
| رمز التحديث: | 20240509 |
| مُعرف محوري في PubMed: | PMC11057813 |
| DOI: | 10.1097/CCE.0000000000001082 |
| PMID: | 38694845 |
| قاعدة البيانات: | MEDLINE |
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