A positive fluid balance is an independent prognostic factor in patients with sepsis

Angela Acheampong, Jean-Louis Vincent, Angela Acheampong, Jean-Louis Vincent

Abstract

Introduction: Intravenous fluid administration is an essential component of sepsis management, but a positive fluid balance has been associated with worse prognosis. We analyzed whether a positive fluid balance and its persistence over time was an independent prognostic factor in septic patients.

Methods: We prospectively studied fluid intake and output for 7 days in 173 consecutive adult patients treated for sepsis in our Department of Intensive Care.

Results: Of the 173 patients, 59 died (34 %). Mean daily fluid intake was higher in non-survivors than in survivors (59 ± 24 ml/kg vs. 48 ± 23 ml/kg, p = 0.03), but output volumes were similar. As a result, the daily fluid balance was more than twice as large in the non-survivors as in the survivors (29 ± 22 vs. 13 ± 19 ml/kg, p <0.001). Persistence of a positive fluid balance over time was associated with increased mortality. Using a multivariable time-dependent Cox model, a positive fluid balance was independently associated with higher mortality (adjusted hazard ratio 1.014 [1.007-1.022] per ml/kg increase, p <0.001).

Conclusions: Persistence of a positive daily fluid balance over time was quite strongly associated with a higher mortality rate in septic patients.

Figures

Fig. 1
Fig. 1
Mean fluid balance (ml/kg) in survivors (S) and non-survivors (NS) over the 7 days after sepsis onset. *Statistically significant difference at the p <0.05 level between survivors and non-survivors
Fig. 2
Fig. 2
Daily intake and output in non-survivors and survivors during the 7-day period
Fig. 3
Fig. 3
Proportion of patients with a negative fluid balance on days 4, 5 and 6 after ICU admission. On the fourth day, 51 of 147 patients had a negative fluid balance, 39 (76.5 %) of whom were survivors (S). On the fifth day, 47 of 118 patients (39.8 %) had a negative mean fluid balance, 38 (80.9 %) of whom were survivors. And on the sixth day, 33 of 102 patients had a negative fluid balance, 26 (78.8 %) of whom were survivors. NS non-survivors

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