Fluid balance status not linked to readmission chances for patients with sepsis:JAMA

Although early fluid administration has been shown to lower sepsis mortality, positive fluid balance has been associated with adverse outcomes. Little is known about associations in non–intensive care unit settings, with growing concern about readmission from excess fluid accumulation in patients with sepsis.

With this knowledge,a team of researchers from the Department of Hospital Medicine, Santa Rosa, California aimed to evaluate whether positive fluid balance among non–critically ill patients with sepsis was associated with increased readmission risk, including readmission for heart failure.

This multicenter retrospective cohort study was conducted between January 1, 2012, and December 31, 2017, among 57 032 non–critically ill adults hospitalized for sepsis at 21 hospitals across Northern California. Kaiser Permanente Northern California is an integrated health care system with a community-based population of more than 4.4 million members. Statistical analysis was performed from January 1 to December 31, 2019. Intake and output net fluid balance were (I/O) measured daily and cumulatively at discharge (positive vs negative). The primary outcome was 30-day readmission. The secondary outcomes were readmission stratified by category and mortality after living discharge.

Results put forth some key facts.

• The cohort included 57 032 patients who were hospitalized for sepsis (28 779 women [50.5%]; mean [SD] age, 73.7 [15.5] years).
• Compared with patients with positive I/O (40 940 [71.8%]), those with negative I/O (16 092 [28.2%]) were older, with increased comorbidity, acute illness severity, preexisting heart failure or chronic kidney disease, diuretic use, and decreased fluid administration volume.
• During 30-day follow-up, 8719 patients (15.3%) were readmitted and 3639 patients (6.4%) died.
• There was no difference in readmission between patients with positive vs negative I/O (HR, 1.00; 95% CI, 0.95-1.05).
• No association was detected between readmission and I/O using continuous, splined, and quadratic function transformations.
• Positive I/O was associated with decreased heart failure–related readmission (HR, 0.80 [95% CI, 0.71-0.91]) and increased 30-day mortality (HR, 1.23 [95% CI, 1.15-1.31]).

"We found that patients with sepsis with positive fluid balance at discharge, with or without heart failure or CKD, had a higher adjusted risk of infection-related readmission. The reasons for this association are unclear. One possibility is that patients in the positive fluid balance group—who had fewer comorbidities and lower acute illness severity than the negative fluid balance group—were more likely to be discharged earlier (indeed, length of stay was shorter), resulting in inadequate management of infection during the index hospitalization. Additional studies are needed to examine the association of fluid status with outcomes in patients with sepsis to reduce readmission risk."the team concluded.

For full article follow the link: doi:10.1001/jamanetworkopen.2021.6105

Primary source: JAMA Network Open