Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China.
BMJ Open. 2020 Dec 28;10(12):e039875. doi: 10.1136/bmjopen-2020-039875.
Fluid management is important in ensuring haemodynamic stability in critically ill patients, but can easily lead to fluid overload (FO). However, the optimal fluid balance plot or range for critically ill patients is unknown. This study aimed to explore the dose-response relationship between FO and in-hospital mortality in critically ill patients.
Multicentre, prospective, observational study.
Eighteen intensive care units (ICUs) of 16 tertiary hospitals in China.
Critically ill patients in the ICU for more than 3 days.
FO was defined as the ratio of the cumulative fluid balance (L) and initial body weight (kg) on ICU admission, expressed as a percentage. Maximum FO was defined as the peak value of FO during the first 3 days of ICU admission. Logistic regression models with restricted cubic splines were used to explore the pattern and magnitude of the association between maximum FO and risk of in-hospital mortality. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score on admission, main diagnosis on admission to ICU, comorbidities, time of maximum FO, mechanical ventilation, renal replacement therapy, use of vasopressors and centres were adjusted in multivariable analysis.
A total of 3850 patients were included in the study, 929 (24.1%) of whom died in the hospital. For each 1% L/kg increase in maximum FO, the risk of in-hospital mortality increased by 4% (adjusted HR (aHR) 1.04, 95% CI 1.03 to 1.05, p<0.001). A maximum FO greater than 10% was associated with a 44% increased HR of in-hospital mortality compared with an FO less than 5% (aHR 1.44, 95% CI 1.27 to 1.67). Notably, we found a non-linear dose-response association between maximum FO and in-hospital mortality.
Both higher and negative fluid balance levels were associated with an increased risk of in-hospital mortality in critically ill patients.
ChiCTR-ECH-13003934.
液体管理对于确保危重症患者的血流动力学稳定非常重要，但很容易导致液体超负荷（FO）。然而，危重症患者的最佳液体平衡图或范围尚不清楚。本研究旨在探讨危重症患者 FO 与住院死亡率之间的剂量-反应关系。
多中心、前瞻性、观察性研究。
中国 16 家三级医院的 18 个重症监护病房（ICU）。
入住 ICU 超过 3 天的危重症患者。
FO 定义为 ICU 入院时累积液体平衡（L）与初始体重（kg）的比值，以百分比表示。最大 FO 定义为 ICU 入院前 3 天内 FO 的峰值。采用受限立方样条的 logistic 回归模型探讨最大 FO 与住院死亡率风险之间的关联模式和幅度。多变量分析中调整了年龄、性别、入院时急性生理学和慢性健康评估 II 评分、入院时序贯器官衰竭评估评分、入住 ICU 时的主要诊断、合并症、最大 FO 时间、机械通气、肾脏替代治疗、血管加压素使用和中心。
共纳入 3850 例患者，其中 929 例（24.1%）在医院死亡。最大 FO 每增加 1% L/kg，住院死亡率的风险增加 4%（调整后的 HR（aHR）1.04，95%CI 1.03 至 1.05，p<0.001）。与 FO<5%相比，最大 FO 大于 10%与住院死亡率增加 44%相关（aHR 1.44，95%CI 1.27 至 1.67）。值得注意的是，我们发现最大 FO 与住院死亡率之间存在非线性剂量反应关系。
液体正平衡和负平衡水平均与危重症患者住院死亡率增加相关。
ChiCTR-ECH-13003934。
