title: Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock.
abstract: OBJECTIVE
  The purpose of this study is to assess whether late positive fluid balances are associated with acute kidney injury and mortality in severe sepsis and septic shock.
  
  
  METHODS
  In this retrospective study, fluid balances were calculated at 3 different time points: the onset of organ dysfunction attributed to sepsis, sepsis diagnosis, and vasopressors initiation. Data were analyzed in logistic regression models for mortality and acute kidney injury as outcomes.
  
  
  RESULTS
  We included 116 patients. A RIFLE score F, diuresis less than 0.9 L from the second day after the first organ dysfunction, and fluid balance more than 3 L between the 24th and the 48th hour after diagnosis were independently associated with higher mortality, whereas in the subgroup with shock, only the latter parameter and diuresis less than 0.85 L on the first day of shock were independent risk factors. After adjusting for age, creatinine more than 1.2 mg/dL, a nonrenal Sequential Organ Failure Assessment greater than or equal to 7.5 on the first day and urine output less than 1.3 L on the first day after organ dysfunction were independent risk factors for RIFLE F. No relationship was found between fluid balance and acute kidney injury.
  
  
  CONCLUSIONS
  Late positive fluid balance is an independent risk factor for mortality in severe sepsis. Positive fluid balances are not associated with either protection against or risk for acute kidney injury.
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Fernando Saes Vilaça
authors.initials: FS
authors.lastname: de Oliveira
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Flavio Geraldo Resende
authors.initials: FG
authors.lastname: Freitas
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Elaine Maria
authors.initials: EM
authors.lastname: Ferreira
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Isac
authors.initials: I
authors.lastname: de Castro
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Antonio Toneti
authors.initials: AT
authors.lastname: Bafi
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Luciano Cesar Pontes
authors.initials: LC
authors.lastname: de Azevedo
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil. Electronic address: frmachado@unifesp.br.
authors.forename: Flavia Ribeiro
authors.initials: FR
authors.lastname: Machado
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004231:Diuresis / Q000502:physiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism* / Q000401:mortality* / Q000503:physiopathology; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014882:Water-Electrolyte Balance / Q000502:physiology*
chemical_list: D014662:Vasoconstrictor Agents
keywords: Fluid balance; Mortality; Severe sepsis