Fluid balance in sepsis and septic shock as a determining factor of mortality
Fluid balance in sepsis and septic shock as a determining factor of mortality
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DOI：
10.1016/j.ajem.2014.11.016
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发表时间：
2015-02-01
影响因子：
3.6
通讯作者：
Lorencio, Carolina
中科院分区：
文献类型：
--
作者：
Sirvent, Josep-Maria;Ferri, Cristina;Lorencio, Carolina
目的：目的是评估液体平衡是否对严重脓毒症或脓毒性休克危重患者的死亡率有决定性影响。设计：对初始队列进行前瞻性观察性研究。地点：地点是一所大学医院的重症监护室。患者：包括重症监护室连续收治的诊断为严重脓毒症或感染性休克的患者。干预措施：登记了人口统计学、实验室和临床数据，以及脓毒症休克发作时间、疾病严重程度（简化急性生理评分II、脓毒症相关器官衰竭评估）和合并症。在24、48、72和96小时记录每日和累积液体平衡。根据Kaplan-Meier法构建28天死亡率生存曲线。结果：共纳入42例患者：男性占64.3%；平均年龄61.8±15.9岁。脓毒性休克占69%。血培养阳性17例（40.5%）。入院时幸存者和非幸存者之间没有观察到年龄、性别、败血症相关器官衰竭评估、肌酐、乳酸、静脉氧饱和度和肌钙蛋白的差异。然而，在非幸存者中观察到更高的简化急性生理评分II， P =。016. 非幸存者在48小时、72小时和96小时时也表现出较高的累积阳性体液平衡，差异有统计学意义。此外，积液平衡大于2.5 L和小于2.5 L的患者的生存曲线和72小时死亡风险有显著差异（P = 0.02）。结论：严重脓毒症或脓毒性休克发病时给予液体治疗是血流动力学治疗的第一线。然而，在前48、72和96小时内积累的体液阳性平衡与这些危重患者较高的死亡率相关。(C) 2014爱思唯尔公司版权所有。
Objective: The objective was to assess whether fluid balance had a determinant impact on mortality rate in a cohort of critically ill patients with severe sepsis or septic shock.Design: A prospective and observational study was carried out on an inception cohort.Setting: The setting was an intensive care unit of a university hospital.Patients: Patients admitted consecutively in the intensive care unit who were diagnosed with severe sepsis or septic shock were included.Interventions: Demographic, laboratory, and clinical data were registered, as well as time of septic shock onset, illness severity (Simplified Acute Physiology Score II, Sepsis-related Organ Failure Assessment), and comorbidities. Daily and accumulated fluid balance was registered at 24, 48, 72, and 96 hours. Survival curves representing 28-day mortality were built according to the Kaplan-Meier method.Results: A total of 42 patients were included in the analysis: men, 64.3%; mean age, 61.8 +/- 15.9 years. Septic shock was predominant in 69% of the cases. Positive blood cultures were obtained in 17 patients (40.5%). No age, sex, Sepsis-related Organ Failure Assessment, creatinine, lactate, venous saturation of O2, and troponin differences were observed upon admission between survivors and nonsurvivors. However, higher Simplified Acute Physiology Score II was observed in nonsurvivors, P =. 016. Nonsurvivors also showed higher accumulated positive fluid balance at 48, 72, and 96 hours with statistically significant differences. Besides, significant differences (P = .02) were observed in the survival curve with the risk of mortality at 72 hours between patients with greater than 2.5 L and less than 2.5 L of accumulated fluid balance.Conclusions: Fluid administration at the onset of severe sepsis or septic shock is the first line of hemodynamic treatment. However, the accumulated positive fluid balance in the first 48, 72, and 96 hours is associated with higher mortality in these critically ill patients. (C) 2014 Elsevier Inc. All rights reserved.