title: Positive fluid balance as a major predictor of clinical outcome of patients with sepsis/septic shock after ICU discharge.
abstract: BACKGROUND
  Sepsis and septic shock continue to be syndromes that carry a high mortality rate worldwide. Early aggressive fluid and vasopressor support have resulted in significant improvement in patient outcomes. The prognostic clinical significance of a positive fluid balance in septic intensive care unit (ICU) patients remains undetermined.
  
  
  METHODS
  We collected data from 297 septic patients hospitalized in our general and medical ICUs at Soroka Medical Center between January 2005 and June 2011 and divided the 4 study groups into the following 4 fluid balances: group 1, patients with fluid balance at discharge from ICU (FBD) less than 10 L; group 2, patients with an FBD of 10 to 20 L; group 3, patients with an FBD of 20 to 30 L; and group 4, patients with FBD in excess of 30 L.
  
  
  RESULTS
  The ICU and in-hospital mortality rate was also significantly higher in groups 2 to 4 as compared with group 1 (P < .001 for both ICU and in-hospital mortality). The positive cumulative FBD was found to be an independent predictor of ICU mortality (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06; P < .001; Table 3) and in-hospital mortality (OR, 1.06; 95% CI, 1.03-1.08; P < .001; Table 5) and also to constitute a risk factor for new organ system dysfunction at hospital discharge (OR, 1.01; 95% CI, 1.01-1.013; P < .001; Table 6) in critically ill patients with severe sepsis/septic shock.
  
  
  CONCLUSIONS
  Although it is a monocentric retrospective study, we suggest that positive cumulative fluid balance is one of the major factors that can predict the clinical outcome of critically ill patients during their ICU stay and after their discharge from the ICU.
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel. Electronic address: bem1975@gmail.com.
authors.forename: Evgeni
authors.initials: E
authors.lastname: Brotfain
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Leonid
authors.initials: L
authors.lastname: Koyfman
authors.affiliation: Clinical Research Center, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Toledano
authors.affiliation: Department of Infectious Disease, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Borer
authors.affiliation: Department of General Medicine, Medical Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Fucs
authors.affiliation: Department of General Medicine, Medical Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Ori
authors.initials: O
authors.lastname: Galante
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Frenkel
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Kutz
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Moti
authors.initials: M
authors.lastname: Klein
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D010351:Patient Discharge; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014882:Water-Electrolyte Balance
chemical_list: D014662:Vasoconstrictor Agents