Department of General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
Wenzhou Key Laboratory of Precision General Practice and Health Management, Wenzhou, 325000, China.
BMC Med. 2024 Oct 24;22(1):492. doi: 10.1186/s12916-024-03715-2.
To determine the optimal fluid resuscitation volume in septic patients with acutely decompensated heart failure (ADHF).
Septic patients with ADHF were identified from a tertiary urban medical center. The generalized additive models were used to explore the association between fluid resuscitation volume and endpoints, and the initial 3 h fluid resuscitation volume was divided into four groups according to this model: < 10 mL/kg group, ≥ 10 to ≤ 15 mL/kg group, > 15 to ≤ 20 mL/kg group, and > 20 mL/kg group. Logistic and Cox regression models were employed to explore the association between resuscitation volume and primary endpoint, in-hospital mortality, as well as secondary endpoints including 30-day mortality, 1-year mortality, invasive ventilation, and ICU admission.
A total of 598 septic patients with a well-documented history of HF were enrolled in the study; 405 patients (68.8%) had sepsis-induced hypoperfusion. Patients with NYHA functional class III and IV were 494 (83.9%) and 22 (3.74%), respectively. Resuscitation volumes above 20 mL/kg (OR 3.19, 95% CI 1.31-8.15) or below 10 mL/kg (OR 2.33, 95% CI 1.14-5.20) significantly increased the risk of in-hospital mortality in septic patients, while resuscitation volumes between 15 and 20 mL/kg were not associated with the risk of in-hospital death in septic patients (OR 1.79, 95% CI 0.68-4.81). In the multivariable Cox models, the effect of resuscitation volume on 30-day and 1-year mortality in septic patients was similar to the effect on in-hospital mortality. Resuscitation volume exceeds 15 mL/kg significantly increased the risk of tracheal intubation, while fluid resuscitation volume was not associated with ICU admission in the septic patients. In septic patients with hypoperfusion, these fluid resuscitation volumes have similar effects on patient outcomes. This association was consistent across the three subgroups with worsened cardiac function, as well as in sensitivity analyses.
Our study observed that an initial fluid resuscitation volume of 10-15 mL/kg in the first 3 h was optimal for early resuscitation in septic patients with ADHF, particularly those with worsened cardiac function. These results need to be confirmed in randomized controlled trials with larger sample sizes.
为了确定患有急性失代偿性心力衰竭（ADHF）的脓毒症患者的最佳液体复苏量。
从一家三级城市医疗中心确定患有 ADHF 的脓毒症患者。使用广义加性模型来探讨液体复苏量与终点之间的关系，并根据该模型将初始 3 小时的液体复苏量分为四组：<10mL/kg 组、≥10 至≤15mL/kg 组、>15 至≤20mL/kg 组和>20mL/kg 组。使用逻辑回归和 Cox 回归模型探讨复苏量与主要终点、院内死亡率以及次要终点（包括 30 天死亡率、1 年死亡率、有创通气和 ICU 入院）之间的关系。
共纳入 598 例有明确 HF 病史的脓毒症患者；405 例（68.8%）患者存在脓毒症诱导的低灌注。NYHA 心功能分级 III 级和 IV 级的患者分别为 494 例（83.9%）和 22 例（3.74%）。复苏量超过 20mL/kg（OR 3.19，95%CI 1.31-8.15）或低于 10mL/kg（OR 2.33，95%CI 1.14-5.20）显著增加了脓毒症患者院内死亡的风险，而 15 至 20mL/kg 之间的复苏量与脓毒症患者的院内死亡风险无关（OR 1.79，95%CI 0.68-4.81）。在多变量 Cox 模型中，复苏量对脓毒症患者 30 天和 1 年死亡率的影响与对院内死亡率的影响相似。复苏量超过 15mL/kg 显著增加了气管插管的风险，而在脓毒症患者中，液体复苏量与 ICU 入院无关。在低灌注的脓毒症患者中，这些液体复苏量对患者结局的影响相似。这种关联在心脏功能恶化的三个亚组以及敏感性分析中是一致的。
我们的研究观察到，在 ADHF 合并脓毒症的患者中，最初 3 小时内 10-15mL/kg 的液体复苏量是早期复苏的最佳选择，特别是心脏功能恶化的患者。这些结果需要在更大样本量的随机对照试验中得到证实。
Zotero 插件
