Kidney Week

Abstract: SA-OR069

Impact of Fluid Balance on One-Year Mortality of Patients with Septic Shock

Session Information

• Tipping the Balance: Fluid and Electrolytes in Health and Disease
  November 04, 2017 | Location: Room 385, Morial Convention Center
  Abstract Time: 06:06 PM - 06:18 PM

Category: Fluid, Electrolytes, and Acid-Base

• 704 Fluid, Electrolyte, Acid-Base Disorders

Authors

• Dhondup, Tsering, Mayo Clinic, Rochester, Minnesota, United States

Tsering Dhondup, MBBS, MPH



Tsering Dhondup MBBS, MPH Fellow Division of Nephrology and Hypertension Mayo Clinic, Rochester, MN, USA

• Tien, Jong-Chie Claudia, Mayo Clinic, Rochester, Minnesota, United States

Jong-Chie Claudia Tien,

• Tan, Hon Liang, Singapore General Hospital, Singapore, Singapore

Hon Liang Tan,

• Marquez, Alberto E, Mayo Clinic, Rochester, Minnesota, United States

Alberto E Marquez,

• Banaei-Kashani, Kianoush, Mayo Clinic, Rochester, Minnesota, United States

Kianoush Banaei-Kashani,

Background

Septic shock patients require early and aggressive volume resuscitation. However, current evidence shows higher risk with the intensity and duration of fluid overload in critically ill patients. In this report, we outline the impact of fluid balance and timing of volume de-resuscitation on outcomes in septic shock patients.

Methods

We retrospectively identified adult septic shock/ severe sepsis patients admitted to the ICU of Mayo Clinic Hospital from January 1^st, 2007 to December 31^st, 2009. Data was abstracted electronically and validated manually. We collected basic demographic, clinical, laboratory and outcome variables. Social security death index was used for missing mortality information. De-resuscitation day was defined as the 1^st day with the negative fluid balance, and KDIGO criteria were used for AKI definition.

Results

A total of 633 patients were included with mean age of 68 years, with 348(55%) being males. Median ICU length of stay was 2.4 (IQR of 1.3-5.5) days, and median daily fluid balance in ICU was 2352 (IQR of 990-4323) ml. The median day-1 SOFA score was 7, and 57 (9%) patients had pre-existing ESRD. In ICU, de-resuscitation was achieved in 443 (70%) patients within [median (IQR)] 2 (1-3) days of ICU admission. Among those starting de-resuscitation in ICU, the average cumulative fluid balance was -1.4 (±5.7) liters. 371 of 576 non-ESRD (64%) patients developed AKI of which 291 patients were admitted with AKI. Eighty (22%) of those with AKI required initiation of dialysis with 63 patients being initiated on CVVH and 17 on intermittent hemodialysis. Adjusted for age, Charlson Comorbidity Index, APACHE III score and day 1 SOFA score, every 1 liter positive cumulative fluid balance was associated with increased hospital mortality (OR of 1.10; 95% CI: 1.06-1.16) in patients who achieved de- resuscitation phase. More interestingly, every 1 liter positive cumulative fluid balance was also associated with increased 1-year mortality (OR of 1.07; 95% CI: 1.03-1.12). Association of positive cumulative fluid balance with increased risk of Hospital and 1-year death remained significant irrespective of pre-existing ESRD or AKI development.

Conclusion

In our cohort of patients with septic shock who achieved de-resuscitation, positive cumulative fluid balance was associated with increased hospital and 1-year mortality.