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Abstract: SA-PO155

Fluid Overload Is a Major Predictor for Mortality in Critically Ill Patients with Cirrhosis and AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Gupta, Mohit, Weill Cornell Medicine, New York, New York, United States
  • Rosenblatt, Russell E., Weill Cornell Medicine, New York, New York, United States
  • Fortune, Brett E., Weill Cornell Medical College, New York, New York, United States
  • Lubetzky, Michelle L., Division of Nephrology and Hypertension, New York, New York, United States
Background


Fluid overload is associated with poor outcomes in critically ill patients with acute kidney injury (AKI), but data on whether this applies to patients with cirrhosis are limited. In the setting of portal hypertension, management of AKI can be challenging due to systemic vasodilatation and ineffective renal arterial blood flow. This study aims to determine whether fluid overload had a detrimental effect on critically ill patients with cirrhosis and AKI.

Methods


Clinical and demographic data from 81 hospitalized patients with cirrhosis transferred to the ICU with AKI were collected from a single academic medical center from 2012-2018. Fluid overload was defined as >10% weight gain after the first 3 days in ICU. The primary endpoint was 14-day survival after hospital admission. Kaplan-Meier survival and adjusted Cox hazards analyses were performed.

Results

There were no significant differences between the two groups in terms of age, sex, or etiology of cirrhosis. Non-survivors had a higher MELD-Na when compared to survivors (30 vs 22.5, p=0.001) at the time of transfer to ICU. Fluid overload in the first 3 days of ICU stay, oliguria, and the use of renal replacement therapy (RRT) were highly associated with mortality (p=0.04, 0.0004 and 0.01 respectively). Unadjusted Kaplan-Meier survival analysis demonstrated inferior 14-day survival for patients who developed fluid overload (36% vs 73%)while in ICU (log-rank p=0.006; Figure 1). A multivariable Cox Hazards model, adjusting for age, MELD-Na, and RRT, demonstrated that fluid overload after 3 days following ICU transfer was associated with a 2.45-fold increased risk of mortality (p=0.02).

Conclusion


Our data demonstrate that fluid overload in critically ill patients with cirrhosis and AKI is major predictor for short-term mortality. Prospective studies that focus on restrictive fluid management are warranted to improve care for this high-risk population.