Wang Tsai-Jung, Pai Kai-Chih, Huang Chun-Te, Wong Li-Ting, Wang Minn-Shyan, Lai Chun-Ming, Chen Cheng-Hsu, Wu Chieh-Liang, Chao Wen-Cheng
Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Front Med (Lausanne). 2022 Mar 3;9:727103. doi: 10.3389/fmed.2022.727103. eCollection 2022.
Early fluid balance has been found to affect short-term mortality in critically ill patients; however, there is little knowledge regarding the association between early cumulative fluid balance (CFB) and long-term mortality. This study aims to determine the distinct association between CFB day 1-3 (CFB 1-3) and day 4-7 (CFB 4-7) and long-term mortality in critically ill patients.
This study was conducted at Taichung Veterans General Hospital, a tertiary care referral center in central Taiwan, by linking the hospital critical care data warehouse 2015-2019 and death registry data of the Taiwanese National Health Research Database. The patients followed up until deceased or the end of the study on 31 December 2019. We use the log-rank test to examine the association between CFB 1-3 and CFB 4-7 with long-term mortality and multivariable Cox regression to identify independent predictors during index admission for long-term mortality in critically ill patients.
A total of 4,610 patients were evaluated. The mean age was 66.4 ± 16.4 years, where 63.8% were men. In patients without shock, a positive CFB 4-7, but not CFB 1-3, was associated with 1-year mortality, while a positive CFB 1-3 and CFB 4-7 had a consistent and excess hazard of 1-year mortality among critically ill patients with shock. The multivariate Cox proportional hazard regression model identified that CFB 1-3 and CFB 4-7 (with per 1-liter increment, HR: 1.047 and 1.094; 95% CI 1.037-1.058 and 1.080-1.108, respectively) were independently associated with high long-term mortality in critically ill patients after adjustment of relevant covariates, including disease severity and the presence of shock.
We found that the fluid balance in the first week, especially on days 4-7, appears to be an early predictor for long-term mortality in critically ill patients. More studies are needed to validate our findings and elucidate underlying mechanisms.
已发现早期液体平衡会影响危重症患者的短期死亡率；然而，关于早期累积液体平衡（CFB）与长期死亡率之间的关联却知之甚少。本研究旨在确定危重症患者第1 - 3天（CFB 1 - 3）和第4 - 7天（CFB 4 - 7）的CFB与长期死亡率之间的独特关联。
本研究在台湾中部的三级医疗转诊中心台中荣民总医院进行，通过关联医院2015 - 2019年重症监护数据仓库和台湾国家卫生研究院数据库的死亡登记数据。患者随访至死亡或2019年12月31日研究结束。我们使用对数秩检验来检验CFB 1 - 3和CFB 4 - 7与长期死亡率之间的关联，并使用多变量Cox回归来确定危重症患者指数住院期间长期死亡率的独立预测因素。
共评估了4610例患者。平均年龄为66.4±16.4岁，其中63.8%为男性。在无休克的患者中，CFB 4 - 7为正与1年死亡率相关，而CFB 1 - 3为正与1年死亡率无关；在有休克的危重症患者中，CFB 1 - 3和CFB 4 - 7为正均与1年死亡率存在一致且额外的风险。多变量Cox比例风险回归模型确定，在调整包括疾病严重程度和休克存在情况等相关协变量后，CFB 1 - 3和CFB 4 - 7（每增加1升，HR分别为1.047和1.094；95%CI分别为1.037 - 1.058和1.080 - 1.108）与危重症患者的高长期死亡率独立相关。
我们发现，第一周尤其是第4 - 7天的液体平衡似乎是危重症患者长期死亡率的早期预测指标。需要更多研究来验证我们的发现并阐明潜在机制。
