title: Association of Fluid Accumulation with Clinical Outcomes in Critically Ill Children with Severe Sepsis.
abstract: OBJECTIVE
  To evaluate whether early and acquired daily fluid overload (FO), as well as fluctuations in fluid accumulation, were associated with adverse outcomes in critically ill children with severe sepsis.
  
  
  METHODS
  This study enrolled 202 children in a pediatric intensive care unit (PICU) with severe sepsis. Early fluid overload was defined as ≥5% fluid accumulation occurring in the first 24 hours of PICU admission. The maximum daily fluid accumulation ≥5% occurring during the next 6 days in patients with at least 48 hours of PICU stay was defined as PICU-acquired daily fluid overload. The fluctuation in fluid accumulation was calculated as the difference between the maximum and the minimum daily fluid accumulation obtained during the first 7 days after admission.
  
  
  RESULTS
  Of the 202 patients, 61 (30.2%) died during PICU stay. Among all patients, 41 (20.3%) experienced early fluid overload, including 9 with a FO ≥10%. Among patients with at least 48 hours of PICU stay (n = 154), 36 (23.4%) developed PICU-acquired daily fluid overload, including 2 with a FO ≥10%. Both early fluid overload (AOR = 1.20; 95% CI 1.08-1.33; P = 0.001; n = 202) and PICU-acquired daily fluid overload (AOR = 5.47 per log increase; 95% CI 1.15-25.96; P = 0.032; n = 154) were independent risk factors associated with mortality after adjusting for age, illness severity, etc. However, fluctuations in fluid accumulation were not associated with mortality after adjustment. Length of PICU stay increased with greater fluctuations in fluid accumulation in all patients with at least 48 hours of PICU stay (FO <5%, 5%-10% vs. ≥10%: 4 [3-8], 7 [4-11] vs. 10 [6-16] days; P <0.001; n = 154) and in survivors (4 [3-8], 7 [5-11] vs. 10 [5-15] days; P <0.001; n = 121). Early fluid overload achieved an area under-the-receiver-operating-characteristic curve of 0.74 (95% CI 0.65-0.82; P <0.001; n = 202) for predicting mortality in patients with severe sepsis, with a sensitivity of 67.2% and a specificity of 80.1% at the optimal cut-off value of 2.65%.
  
  
  CONCLUSIONS
  Both early and acquired daily fluid overload were independently associated with PICU mortality in children with severe sepsis.
authors.affiliation: Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.|Department of Nephrology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
authors.forename: Jiao
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
authors.forename: Xiaozhong
authors.initials: X
authors.lastname: Li
authors.affiliation: Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
authors.forename: Zhenjiang
authors.initials: Z
authors.lastname: Bai
authors.affiliation: Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.affiliation: Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Hua
authors.affiliation: Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Pan
authors.affiliation: Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Neonatology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Feng
authors.affiliation: Department of Nephrology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.|Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D018805:Sepsis / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome