Fluid balance and cardiac function in septic shock as predictors of hospital mortality.
Fluid balance and cardiac function in septic shock as predictors of hospital mortality.
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DOI：
10.1186/cc13072
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发表时间：
2013-10-20
期刊：
影响因子：
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通讯作者：
Kollef MH
中科院分区：
文献类型：
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作者：
Micek ST;McEvoy C;McKenzie M;Hampton N;Doherty JA;Kollef MH
感染性休克是世界范围内发病率和死亡率的主要原因。不幸的是，感染性休克的最佳液体管理是未知的，目前是经验。在Barnes-Jewish医院（圣路易斯，密苏里州）进行了回顾性分析。连续性患者（n = 325）因感染性休克住院，并在休克发作后24小时内进行超声心动图检查。共163例（50.2%）感染性休克患者在住院期间死亡。在感染性休克发作的24小时窗口内，非存活者具有显著更大的正净液体平衡（中位数（IQR）：4，374 ml（1，637 ml，7，260 ml）vs. 2，959 ml（1，639.5 ml，4，769.5 ml），P = 0.004）。休克发作后24小时和8天的正净液体平衡的最大四分位数分别被发现预测住院死亡率，休克发作后8天的正净液体平衡的最大四分位数是住院死亡率的独立预测因子（校正比值比（AOR），1.66; 95%CI，1.39至1.98; P = 0.004）。经床旁超声心动图评估，存活者更有可能出现轻度左心室功能障碍，而非存活者左心室射血分数略有升高，这也被认为是结局的独立预测因素。我们的数据证实了液体平衡和心功能作为脓毒性休克患者预后预测因子的重要性。需要进行临床试验以确定感染性休克患者静脉输液的最佳给药方式。
Septic shock is a major cause of morbidity and mortality throughout the world. Unfortunately, the optimal fluid management of septic shock is unknown and currently is empirical. A retrospective analysis was performed at Barnes-Jewish Hospital (St. Louis, Missouri). Consecutive patients (n = 325) hospitalized with septic shock who had echocardiographic examinations performed within 24 hours of shock onset were enrolled. A total of 163 (50.2%) patients with septic shock died during hospitalization. Non-survivors had a significantly larger positive net fluid balance within the 24 hour window of septic shock onset (median (IQR): 4,374 ml (1,637 ml, 7,260 ml) vs. 2,959 ml (1,639.5 ml, 4,769.5 ml), P = 0.004). The greatest quartile of positive net fluid balance at 24 hours and eight days post-shock onset respectively were found to predict hospital mortality, and the greatest quartile of positive net fluid balance at eight days post-shock onset was an independent predictor of hospital mortality (adjusted odds ratio (AOR), 1.66; 95% CI, 1.39 to 1.98; P = 0.004). Survivors were significantly more likely to have mild left ventricular dysfunction as evaluated by bedside echocardiography and non-survivors had slightly elevated left ventricular ejection fraction, which was also found to be an independent predictor of outcome. Our data confirms the importance of fluid balance and cardiac function as outcome predictors in patients with septic shock. A clinical trial to determine the optimal administration of intravenous fluids to patients with septic shock is needed.