The association between increasing fluid balance, acute kidney injury and mortality in patients with sepsis and septic shock: A retrospective single center audit

• Published in: Journal of critical care Vol. 78; p. 154367
• Main Authors: Tackaert, Thomas, Van Moorter, Nina, De Mey, Nathalie, Demeyer, Ignace, De Decker, Koen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2023; Elsevier Limited
• Subjects: Catheters; Creatinine; Electronic health records; Emergency medical care; Fluid output; Fluid therapy; Fluids; Hemodialysis; ICU mortality; Infections; Intensive care; Kidney diseases; Mortality; Multivariate analysis; Outcome; Patient admissions; Peritoneal dialysis; Renal replacement therapy; Sepsis; Septic shock; Urine; Ventilators; Belgium; OR; Fluid therapy; Fluid output; Septic shock; Multivariate analysis; MDRD; EHR; AUC; AKIN; BSA; LOS; SOFA; RRT; Outcome; KDIGO; Sepsis; ICU mortality; ICU; CKD; AKI; BMI; ED
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2023.154367

To determine whether a positive fluid balance is associated with AKI and mortality in sepsis and septic shock patients. A retrospective chart review of 482 patients treated for sepsis or septic shock. Patients were stratified according to quartiles of cumulative fluid balance on days 1 and 3. Logistic models were built to explore the association between fluid balance, AKI, and ICU mortality. During the first days of ICU admission, fluid input did not differ between survivors and non-survivors, yet a significant difference in output resulted in a more positive fluid balance in non-survivors on day 1 (37.24 ± 31.98 ml/kg vs. 24.97 ± 23.76 ml/kg, p < 0.001) and day 3 (83.33 ± 70.86 ml/kg vs. 62.20 ± 45.90 ml/kg, P = 0.005). Using a logistic regression model, a positive fluid balance on day three was independently associated with higher ICU mortality (odds ratio 1.007 for every one ml/kg, P = 0038) and AKIN stage III (odds ratio 1.006 for every one ml/kg, p = 0.031). In patients with sepsis and septic shock, a more positive fluid balance is associated with an increased incidence of acute kidney injury and death after correction for possible confounders. [Display omitted] •This study conducted a single-center audit of patients with sepsis or septic shock.•Non-survivors had significantly lower urine output, despite similar fluid input.•Resulting in a more positive fluid balance.•This positive fluid balance was independently associated with ICU mortality and the occurrence of acute kidney injury.