The risk factors and prognosis of septic shock patients treated with fluid overload / 中华急诊医学杂志

ABSTRACT

Objective To investigate the risk factors and prognosis of fl uid overload in patients with septic shock in order to provide guidelines for the reasonable optimization of fluid resuscitation to improve the prognosis of patients with septic shock. Methods A total of 203 septic shock patients admitted in ICU of the fi rst Hospital of Jinlin University from July 2013 to December 2016 were enrolled for retrospective study. The clinical data of all patients were collected to analyzed the differences in clinical settings and outcomes between fluid overload group (n=51) and non-fluid overload group (n=152). The risk factors of fluid overload were achieved using multiple logistic regression analysis. Results Compared with non-fl uid overload group, there were statistically higher levels of APACHE II score(27.5± 9.8 vs.22.7± 9.2,P=0.03),rate of congestive heart failure(17.6% vs.9.2%,P=0.02),rate of acute kidney injury(47.1% vs.29.6%, P=0.04), rate of liver cirrhosis(17.6% vs.9.2%,P=0.02), percentage of albumin≤20 g/L(39.2% vs.36.2%,P=0.03),percentage of blood transfusion(43.1% vs.15.1%,P=0.04), percentage of mechanical ventilation employed(64.7% vs.39.5%,P=0.02),volume of fluid infusion in 24 h(8.3 L vs.5.8 L,P=0.01),rate of renal replacement therapy(15.7% vs.7.9%,P=0.02),and mean duration of mechanical ventilation(4.5 d vs.2.6 d,P<0.01)found in fluid overload group.The hospital mortality of fluid overload group was higher than that of non-fluid overload group(45.1% vs.34.9%,P=0.01).The length of ICU stay in fluid overload group was longer than that of non-fluid overload group(6.8 d vs.3.8 d, P=0.02). The ICU re-admission rate within 48 h in fl uid overload group was higher than that in non-fluid overload group(7.8% vs.3.9%,P=0.03).with free fluid infusion without meticulous calculation of fluid volume(OR=2.65,95%CI1.33-5.28,P=0.01)and serum albumin≤20 g/L(OR=2.35,95%CI1.24-4.21,P=0.04)were more likely to develop fluid overload. Conclusion Fluid overload in septic shock patents is associated with poor prognosis. Free fl uid infusion without careful calculation of fl uid volume and severe hypo-albuminemia are the independent risk factors of fl uid overload in septic shock patients.