title: A positive fluid balance is an independent prognostic factor in patients with sepsis.
abstract: BACKGROUND
  Intravenous fluid administration is an essential component of sepsis management, but a positive fluid balance has been associated with worse prognosis. We analyzed whether a positive fluid balance and its persistence over time was an independent prognostic factor in septic patients.
  
  
  METHODS
  We prospectively studied fluid intake and output for 7 days in 173 consecutive adult patients treated for sepsis in our Department of Intensive Care.
  
  
  RESULTS
  Of the 173 patients, 59 died (34 %). Mean daily fluid intake was higher in non-survivors than in survivors (59 ± 24 ml/kg vs. 48 ± 23 ml/kg, p = 0.03), but output volumes were similar. As a result, the daily fluid balance was more than twice as large in the non-survivors as in the survivors (29 ± 22 vs. 13 ± 19 ml/kg, p <0.001). Persistence of a positive fluid balance over time was associated with increased mortality. Using a multivariable time-dependent Cox model, a positive fluid balance was independently associated with higher mortality (adjusted hazard ratio 1.014 [1.007-1.022] per ml/kg increase, p <0.001).
  
  
  CONCLUSIONS
  Persistence of a positive daily fluid balance over time was quite strongly associated with a higher mortality rate in septic patients.
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium. Angela.Acheampong@ulb.ac.be.
authors.forename: Angela
authors.initials: A
authors.lastname: Acheampong
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium. jlvincen@ulb.ac.be.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000367:Age Factors; D001530:Belgium / Q000453:epidemiology; D003967:Diarrhea; D004232:Diuretics / Q000627:therapeutic use; D004322:Drainage; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D018805:Sepsis / Q000401:mortality*; D014556:Urine; D014882:Water-Electrolyte Balance
chemical_list: D004232:Diuretics