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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study

Authors: Yanfei Shen, Xinmei Huang, Weimin Zhang

Published in: Critical Care | Issue 1/2017

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Abstract

Background

Compared to positive fluid balance (FB), negative FB is associated with improved clinical outcomes in critically ill patients. However, as to whether achieving more negative FB can further improve outcomes has not been investigated. This study aimed to investigate whether more negative FB and restricted fluid intake were associated with improved outcomes in critically ill patients.

Method

Data were extracted from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. Patients achieving negative FB at 48 hours after intensive care unit (ICU) admission were screened. The primary outcome was hospital mortality. Logistic models were built to explore the association between FB, fluid intake and mortality, using FB and fluid intake (both four levels) as design variables and using the linear spline function method.

Results

There were 2068 patients meeting the inclusion criteria. Compared to slight negative FB (level 1), there was a decreased tendency towards mortality with FB level 2 (OR 0.88, 95% CI 0.69–1.11) and level 3 (OR 0.79, 95% CI 0. 65–1.11); however, only extreme negative FB (level 4) was significant (OR 0.56, 95% CI 0. 33–0.95). Fluid intake and urine output were evenly distributed over the first 48 hours after ICU admission. Fluid intake was inversely associated with hospital mortality, with the OR decreased stepwise from level 2 (OR 0.73, 95% CI 0.56–0.96) to level 4 (OR 0.47, 95% CI 0.30–0.74), referred to level 1. Urine output also showed a similar pattern. Diuretic use was associated with higher mortality in both models.

Conclusion

In critically ill patients with negative FB, both increased fluid intake and urine output were associated with decreased hospital mortality. However, compared to slight FB, achieving more negative FB was not associated with reduced mortality.
Appendix
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Literature
1.
2.
Brotfain E, Koyfman L, Toledano R, Borer A, Fucs L, Galante O, Frenkel A, Kutz R, Klein M. Positive fluid balance as a major predictor of clinical outcome of patients with sepsis/septic shock after discharge from intensive care unit. Am J Emerg Med. 2016;34(11):2122–6.
3.
Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):259–65.CrossRefPubMed
4.
Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008;12(3):R74.CrossRefPubMedPubMedCentral
5.
Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors Jr AF, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–75.CrossRefPubMed
6.
Sakr Y, Dunisch P, Santos C, Matthes L, Zeidan M, Reinhart K, Kalff R, Ewald C. Poor outcome is associated with less negative fluid balance in patients with aneurysmal subarachnoid hemorrhage treated with prophylactic vasopressor-induced hypertension. Ann Intensive Care. 2016;6(1):25.CrossRefPubMedPubMedCentral
7.
Barmparas G, Liou D, Lee D, Fierro N, Bloom M, Ley E, Salim A, Bukur M. Impact of positive fluid balance on critically ill surgical patients: a prospective observational study. J Crit Care. 2014;29(6):936–41.CrossRefPubMed
8.
Wang N, Jiang L, Zhu B, Wen Y, Xi XM. Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study. Crit Care. 2015;19:371.CrossRefPubMedPubMedCentral
9.
Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, Van Regenmortel N. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361–80.CrossRefPubMed
10.
Johnson AE, Pollard TJ, Shen L, Lehman LW, Feng M, Ghassemi M, Moody B, Szolovits P, Celi LA, Mark RG. MIMIC-III, a freely accessible critical care database. Sci Data. 2016;3:160035.CrossRefPubMedPubMedCentral
11.
Goldberger AL, Amaral LA, Glass L, Hausdorff JM, Ivanov PC, Mark RG, Mietus JE, Moody GB, Peng CK, Stanley HE. PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals. Circulation. 2000;101(23):E215–220.CrossRefPubMed
12.
13.
14.
15.
Alsous F, Khamiees M, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot study. Chest. 2000;117(6):1749–54.CrossRefPubMed
16.
Kissoon NR, Mandrekar JN, Fugate JE, Lanzino G, Wijdicks EF, Rabinstein AA. Positive fluid balance is associated with poor outcomes in subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2015;24(10):2245–51.CrossRefPubMed
17.
de Almeida JP, Palomba H, Galas FR, Fukushima JT, Duarte FA, Nagaoka D, Torres V, Yu L, Vincent JL, Auler Jr JO, et al. Positive fluid balance is associated with reduced survival in critically ill patients with cancer. Acta Anaesthesiol Scand. 2012;56(6):712–7.CrossRefPubMed
18.
Silva Jr JM, de Oliveira AM, Nogueira FA, Vianna PM, Pereira Filho MC, Dias LF, Maia VP, Neucamp Cde S, Amendola CP, Carmona MJ, et al. The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study. Crit Care. 2013;17(6):R288.CrossRefPubMedPubMedCentral
19.
Wang CH, Hsieh WH, Chou HC, Huang YS, Shen JH, Yeo YH, Chang HE, Chen SC, Lee CC. Liberal versus restricted fluid resuscitation strategies in trauma patients: a systematic review and meta-analysis of randomized controlled trials and observational studies*. Crit Care Med. 2014;42(4):954–61.CrossRefPubMed
20.
Holst M, Stromberg A, Lindholm M, Willenheimer R. Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure: result of a randomised cross-over study of the effects on health-related quality of life, physical capacity, thirst and morbidity. Scand Cardiovasc J. 2008;42(5):316–22.CrossRefPubMed
21.
Sinitsky L, Walls D, Nadel S, Inwald DP. Fluid overload at 48 hours is associated with respiratory morbidity but not mortality in a general PICU: retrospective cohort study. Pediatr Crit Care Med. 2015;16(3):205–9.CrossRefPubMed
22.
Semler MW, Wheeler AP, Thompson BT, Bernard GR, Wiedemann HP, Rice TW. Impact of initial central venous pressure on outcomes of conservative versus liberal fluid management in acute respiratory distress syndrome. Crit Care Med. 2016;44(4):782–9.PubMedPubMedCentral
23.
Hjortrup PB, Haase N, Bundgaard H, Thomsen SL, Winding R, Pettila V, Aaen A, Lodahl D, Berthelsen RE, Christensen H, et al. Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Med. 2016;42(11):1695–705.CrossRefPubMed
24.
Chen C, Kollef MH. Targeted fluid minimization following initial resuscitation in septic shock: a pilot study. Chest. 2015;148(6):1462–9.CrossRefPubMed
25.
Silversides JA, Major E, Ferguson AJ, Mann EE, McAuley DF, Marshall JC, Blackwood B, Fan E. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive Care Med. 2017;43(2):155–70.CrossRefPubMed
Metadata
Title
Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study
Authors
Yanfei Shen
Xinmei Huang
Weimin Zhang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1692-3

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