Abstract: TH-PO0747
Fluid Overload After Guideline-Directed Resuscitation in Sepsis
Session Information
- AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Rhee, Harin, Pusan National University School of Medicine, Busan, Korea (the Republic of)
- Kim, Jinmi, Pusan National University Hospital, Busan, Korea (the Republic of)
Group or Team Name
- Korean Sepsis Alliance
Background
It is unclear whether following survival sepsis campaign (SSC) guided fluid resuscitation causes fluid overload (FO) with which influence clinical outcomes in patients with sepsis and hypotension.
Methods
This is a multicenter prospective observation study included adult (age ≥ 19 years) patients diagnosed with sepsis in South Korea. Sepsis was defined according to the Sepsis-3 criteria .FO was defined as an accumulation of fluid more than 5% of predictive body weight. We categorized patients into four groups depending on the receipt of initial fluid resuscitation (at least 30mL/kg) and the development of FO. The outcome was the mortality at intensive care unit (ICU).
Results
Among 5,394 patients with sepsis and hypotension, admitted to the ICU between 2019 and 2023, 91.6% received guideline directed initial fluid resuscitation. FO on ICU day 1 observed in 27.2% of patients, and was more common in those received SSC-directed fluid therapy than in those who did not (28.6% vs. 11.9%, p<0.001). During a median follow-up of 5 days, ICU mortality was 22%. In the multivariable Cox proportional hazards model adjusted for comorbidities and disease severity, patients who received SSC-directed fluid therapy and subsequently developed fluid overload (FO) had an increased risk of ICU mortality (HR 1.28, 95% CI 1.11–1.46), whereas those who received fluid resuscitation without developing FO showed a lower mortality risk (HR 0.81, 95% CI 0.65–1.01), compared with patients who neither received fluid resuscitation nor developed FO. Older age, female sex, acute kidney injury, and initial fluid resuscitation were independently associated with the development of FO.
Conclusion
Our data support the importance of individualized fluid resuscitation in adult patients with sepsis and hypotension.