title: Impact of positive fluid balance on mortality and length of stay in septic shock patients.
abstract: BACKGROUND
  Fluid management is important in critically patients. The aim of this study was to determine the relationship between fluid balance and adverse outcomes of septic shock.
  
  
  METHODS
  A retrospective study was conducted in the medical Intensive Care Unit (ICU) of a tertiary university hospital in Thailand, over a 7-year period.
  
  
  RESULTS
  A total of 1048 patients with an ICU mortality rate of 47% were enrolled. The median cumulative fluid intake at 24, 48, and 72 h from septic shock onset were 4.2, 7.7, and 10.5 L, respectively. Nonsurvivors had a significantly higher median cumulative fluid intake at 24, 48, and 72 h (4.6 vs. 3.9 L, 8.2 vs. 7.1 L, and 11.4 vs. 9.9 L, respectively, P < 0.001 for all). Nonsurvivors also had a significantly higher cumulative and mean fluid balance within 72 h (5.4 vs. 4.4 L and 2.8 vs. 1.6 L, P < 0.001 for both). In multivariate logistic regression analysis, mean fluid balance quartile within 72 h, was independently associated with an increase in ICU and hospital mortality. Quartile 3 and 4 have statistically significant increases in mortality compared with quartile 1 (odds ratio [95% confidence interval] 3.04 [1.9-4.48] and 4.16 [2.49-6.95] for ICU mortality and 2.75 [1.74-4.36] and 3.16 [1.87-5.35] for hospital mortality, respectively, P < 0.001 for all). In addition, the higher amount of mean fluid balance was associated with prolonged ICU stays.
  
  
  CONCLUSIONS
  Positive fluid balance over 3 days is associated with increased ICU and hospital mortality along with prolonged ICU stays in septic shock patients.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
authors.forename: Wachiraporn
authors.initials: W
authors.lastname: Koonrangsesomboon
authors.affiliation: Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
authors.forename: Bodin
authors.initials: B
authors.lastname: Khwannimit
keywords: Fluid; fluid balance; mortality; prognostic factor; septic shock
references.citation: Crit Care. 2013 Oct 20;17 (5):R246
references.pmid: 24138869
references.citation: J Crit Care. 2015 Feb;30(1):97-101
references.pmid: 25269788
references.citation: Intensive Care Med. 2012 Oct;38(10):1573-82
references.pmid: 22926653
references.citation: Crit Care. 2012 May 08;16(3):R76
references.pmid: 22568926
references.citation: N Engl J Med. 2006 Jun 15;354(24):2564-75
references.pmid: 16714767
references.citation: Crit Care Med. 2003 Apr;31(4):1250-6
references.pmid: 12682500
references.citation: Ann Intensive Care. 2012 Jul 05;2(Suppl 1 Diagnosis and management of intra-abdominal hyperten):S1
references.pmid: 22873410
references.citation: J Intern Med. 2015 Apr;277(4):468-77
references.pmid: 24931482
references.citation: Intensive Care Med. 2013 Feb;39(2):165-228
references.pmid: 23361625
references.citation: Crit Care Med. 2011 Feb;39(2):259-65
references.pmid: 20975548
references.citation: Epidemiol Infect. 2009 Sep;137(9):1333-41
references.pmid: 19192320
references.citation: J Crit Care. 2014 Feb;29(1):43-8
references.pmid: 24140168
references.citation: J Crit Care. 2014 Dec;29(6):936-41
references.pmid: 25085510
references.citation: Crit Care. 2012 May 31;16(3):R99
references.pmid: 22651844
references.citation: Crit Care Med. 2006 Feb;34(2):344-53
references.pmid: 16424713
references.citation: Chest. 2009 Jul;136(1):102-9
references.pmid: 19318675
references.citation: Acta Anaesthesiol Scand. 2012 Jul;56(6):712-7
references.pmid: 22621427
references.citation: Br J Anaesth. 2014 Nov;113(5):764-71
references.pmid: 25182016
references.citation: J Emerg Med. 2006 Aug;31(2):185-99
references.pmid: 17044583
references.citation: N Engl J Med. 2001 Nov 8;345(19):1368-77
references.pmid: 11794169
references.citation: Chest. 2014 Oct;146(4):908-15
references.pmid: 24853382
references.citation: Anaesthesiol Intensive Ther. 2014 Nov-Dec;46(5):361-80
references.pmid: 25432556
references.citation: Intensive Care Med. 1996 Jul;22(7):707-10
references.pmid: 8844239
references.citation: Kidney Int. 2009 Aug;76(4):422-7
references.pmid: 19436332
references.citation: Crit Care. 2013 Dec 10;17(6):R288
references.pmid: 24326085
references.citation: Br J Anaesth. 2014 Nov;113(5):756-63
references.pmid: 25209097
references.citation: Crit Care. 2013 Jan 24;17(1):R14
references.pmid: 23347825
references.citation: Am J Respir Crit Care Med. 2013 Jul 1;188(1):77-82
references.pmid: 23631750
references.citation: Nephrol Dial Transplant. 2012 Mar;27(3):956-61
references.pmid: 21856761
references.citation: Crit Care Med. 1985 Oct;13(10):818-29
references.pmid: 3928249