Higher cumulative fluid balance in ICU patients with sepsis tied to major adverse kidney events

Recent research found that Patients admitted to ICU due to sepsis and with higher cumulative fluid balance for 2 days subsequently developed major Adverse kidney events within 30 days. The study was published in 'Annals of Intensive Care.'

The mainstay of treatment for hemodynamic instability during the early phase of sepsis is Fluid resuscitation. But conventional fluid resuscitation along with other maintenance fluids may lead to fluid accumulation which can lead to major adverse kidney events within 30 days (MAKE30). So, researchers from Sweden ad Italy conducted a study to find the association between cumulative fluid balance and major adverse kidney events within 30 days (MAKE30), a composite of death, dialysis, or sustained renal dysfunction, in such patients.

Researchers conducted a multicenter, retrospective observational study on 1834 septic patients admitted to five ICUs in three hospitals in Stockholm, Sweden. To assess the association between cumulative fluid balance during the first two days in ICU and subsequent risk of MAKE30, adjusted for demographic factors, comorbidities, baseline creatinine, illness severity variables, hemodynamic characteristics, chloride exposure, and nephrotoxic drug exposure logistic regression analysis was used. The strength of significant exposure variables using a relative importance analysis was also assessed.

Key findings:

• 519 (28.3%) patients developed MAKE30.
• Median (IQR) cumulative fluid balance was 5.3 (2.8–8.1) l in the MAKE30 group and 4.1 (1.9–6.8) l in the no MAKE30 group, with non-resuscitation fluids contributing to approximately half of the total fluid input in each group.
• The adjusted odds ratio for MAKE30 was 1.05 per liter cumulative fluid balance.
• The strongest factors regarding MAKE30 were, in decreasing order, baseline creatinine, cumulative fluid balance, and age on relative importance analysis.
• The adjusted odds ratio for dialysis or sustained renal dysfunction was 1.06 per liter cumulative fluid balance in the secondary outcome analysis.
• Lower urine output and early acute kidney injury, respectively, were independently associated with MAKE30, whereas higher fluid input was not on separate sensitivity analyses.

Thus the researchers concluded that patients in ICU with sepsis had a higher cumulative fluid balance after 2 days in ICU and were associated with subsequent development of major adverse kidney events within 30 days. Death, renal replacement requirement, or persistent renal dysfunction were also associated with the adverse events.

For the full article, click here: https://doi.org/10.1186/s13613-022-01040-6

Mele, A., Cerminara, E., Häbel, H. et al. Fluid accumulation and major adverse kidney events in sepsis: a multicenter observational study. Ann. Intensive Care 12, 62 (2022).