机构:[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首都医科大学宣武医院[4]Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
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% confidence interval (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.
基金:
National Science and Technology Supporting Plan of the Ministry of Science and Technology of China [2012BAI11B05]
第一作者机构:[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
通讯作者:
推荐引用方式(GB/T 7714):
Wang Mei-Ping,Jiang Li,Zhu Bo,et al.Association of fluid balance trajectories with clinical outcomes in patients with septic shock: a prospective multicenter cohort study[J].MILITARY MEDICAL RESEARCH.2021,8(1):doi:10.1186/s40779-021-00328-1.
APA:
Wang, Mei-Ping,Jiang, Li,Zhu, Bo,Du, Bin,Li, Wen...&Xi, Xiu-Ming.(2021).Association of fluid balance trajectories with clinical outcomes in patients with septic shock: a prospective multicenter cohort study.MILITARY MEDICAL RESEARCH,8,(1)
MLA:
Wang, Mei-Ping,et al."Association of fluid balance trajectories with clinical outcomes in patients with septic shock: a prospective multicenter cohort study".MILITARY MEDICAL RESEARCH 8..1(2021)