title: Positive fluid balance is associated with reduced survival in critically ill patients with cancer.
abstract: BACKGROUND
  There are no studies that describe the impact of the cumulative fluid balance on the outcomes of cancer patients admitted to intensive care units ICUs. The aim of our study was to evaluate the relationship between fluid balance and clinical outcomes in these patients.
  
  
  METHODS
  One hundred twenty-two cancer patients were prospectively evaluated for survival during a 30-day period. Univariate (Chi-square, t-test, Mann-Whitney) and multiple logistic regression analyses were used to identify the admission parameters associated with mortality.
  
  
  RESULTS
  The mean cumulative fluid balance was significantly higher in non-survivors than in survivors [1675 ml/24 h (471-2921) vs. 887 ml/24 h (104-557), P = 0.017]. We used the area under the curve and the intersection of the sensibility and specificity curves to define a cumulative fluid balance value of 1100 ml/24 h. This value was used in the univariate model. In the multivariate model, the following variables were significantly associated with mortality in cancer patients: the Acute Physiology and Chronic Health Evaluation II score at admission [Odds ratio (OR) 1.15; 95% confidence interval (CI) (1.05-1.26), P = 0.003], the Lung Injury Score at admission [OR 2.23; 95% CI (1.29-3.87), P = 0.004] and a positive fluid balance higher than 1100 ml/24 h at ICU [OR 5.14; 95% CI (1.45-18.24), P = 0.011].
  
  
  CONCLUSIONS
  A cumulative positive fluid balance higher than 1100 ml/24 h was independently associated with mortality in patients with cancer. These findings highlight the importance of improving the evaluation of these patients' volemic state and indicate that defined goals should be used to guide fluid therapy.
authors.affiliation: Cancer Institute, Department of Anesthesiology and Critical Care, Intensive Care Unit, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil. juliano.almeida@usp.br
authors.forename: J P
authors.initials: JP
authors.lastname: de Almeida
authors.forename: H
authors.initials: H
authors.lastname: Palomba
authors.forename: F R B G
authors.initials: FR
authors.lastname: Galas
authors.forename: J T
authors.initials: JT
authors.lastname: Fukushima
authors.forename: F A
authors.initials: FA
authors.lastname: Duarte
authors.forename: D
authors.initials: D
authors.lastname: Nagaoka
authors.forename: V
authors.initials: V
authors.lastname: Torres
authors.forename: L
authors.initials: L
authors.lastname: Yu
authors.forename: J-L
authors.initials: JL
authors.lastname: Vincent
authors.forename: J O C
authors.initials: JO
authors.lastname: Auler
authors.forename: L A
authors.initials: LA
authors.lastname: Hajjar
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D019540:Area Under Curve; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality / Q000503:physiopathology; D009369:Neoplasms / Q000401:mortality* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000209:etiology / Q000503:physiopathology; D013534:Survival; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014882:Water-Electrolyte Balance / Q000502:physiology*
chemical_list: D014662:Vasoconstrictor Agents