Association of fluid balance trajectories with clinical outcomes in patients with septic shock:A prospective multicenter cohort study  

作　　者：Mei-Ping Wang Li Jiang Bo Zhu Bin Du Wen Li Yan He Xiu-Ming Xi China Critical Care Sepsis Trial(CCCST)workgroup 

机构地区：[1]Department of Epidemiology and Health Statistics,School of Public Health,Capital Medical University,No.10,Xitoutiao,You’anmen,Beijing,Fengtai District,China [2]Department of Critical Care Medicine,Fuxing Hospital,Capital Medical University,No.20,Street Fuxingmenwai,Beijing,Xicheng District,China [3]Department of Critical Care Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China [4]Medical Intensive Care Unit,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China

出　　处：《Military Medical Research》2021年第3期395-404,共10页军事医学研究（英文版）

基　　金：supported by the National Science and Technology Supporting Plan of the Ministry of Science and Technology of China(2012BAI11B05)。

摘　　要：Background:Septic shock has a high incidence and mortality rate in Intensive Care Units(ICUs).Earlier intravenous fluid resuscitation can significantly improve outcomes in septic patients but easily leads to fluid overload(FO),which is associated with poor clinical outcomes.A single point value of fluid cannot provide enough fluid information.The aim of this study was to investigate the impact of fluid balance(FB)latent trajectories on clinical outcomes in septic patients.Methods:Patients were diagnosed with septic shock during the first 48 h,and sequential fluid data for the first 3 days of ICU admission were included.A group-based trajectory model(GBTM)which is designed to identify groups of individuals following similar developmental trajectories was used to identify latent subgroups of individuals following a similar progression of FB.The primary outcomes were hospital mortality,organ dysfunction,major adverse kidney events(MAKE)and severe respiratory adverse events(SRAE).We used multivariable Cox or logistic regression analysis to assess the association between FB trajectories and clinical outcomes.Results:Nine hundred eighty-six patients met the inclusion criteria and were assigned to GBTM analysis,and three latent FB trajectories were detected.64(6.5%),841(85.3%),and 81(8.2%)patients were identified to have decreased,low,and high FB,respectively.Compared with low FB,high FB was associated with increased hospital mortality[hazard ratio(HR)=1.63,95%CI 1.22–2.17],organ dysfunction[odds ratio(OR)=2.18,95%CI 1.22–3.42],MAKE(OR=1.80,95%CI 1.04–2.63)and SRAE(OR=2.33,95%CI 1.46–3.71),and decreasing FB was significantly associated with decreased MAKE(OR=0.46,95%CI 0.29–0.79)after adjustment for potential covariates.Conclusion:Latent subgroups of septic patients followed a similar FB progression.These latent fluid trajectories were associated with clinical outcomes.The decreasing FB trajectory was associated with a decreased risk of hospital mortality and MAKE.

关 键 词：Septic shock Fluid overload Group-based trajectory model Clinical outcomes 

分 类 号：R459.7[医药卫生—急诊医学]