Assessing the impact of CKD on outcomes in septic shock patients receiving standard Vs reduced initial fluid volume.

OBJECTIVE: To determine if following fluid resuscitation recommendations in the Surviving Sepsis Campaign guidelines affects hospital length of stay (LOS) in chronic kidney disease (CKD) patients who present to the emergency department with sepsis-induced hypotension or septic shock. DESIGN: Retrospective, single center, cohort study. SETTING: 433-bed community hospital with a 35-bed emergency department in central Kentucky. PATIENTS: Adults (≥18 years of age) who presented to the emergency department with severe sepsis or septic shock, as defined by the Centers for Medicare and Medicaid Services (CMS), with documented CKD and at least one episode of hypotension within 6 h of presentation. A total of 106 patients were included in the study. MEASUREMENTS AND MAIN RESULTS: Patients were stratified into two groups based on the total volume of weight-based crystalloid fluid bolus initiated within the first three hours of hypotension onset (<27 mL/kg and ≥ 27 mL/kg). There was a statistically significant reduction in the primary outcome of median LOS among patients who received less than 27 mL/kg of a crystalloid fluid bolus (5.1 vs 7.7 days, p = .003). Likewise, there was a statistically significant reduction in the secondary outcome of total cost per case in the reduced fluid volume cohort (p = .019. No significant differences were found in other secondary outcomes, including vasopressor requirements, ICU admission rate, and normalization of MAP at 6 h. CONCLUSION: The results of this single-center, retrospective study indicate that CKD patients who receive guideline-directed fluid resuscitation (≥27 mL/kg) for sepsis-induced hypotension or septic shock experience a longer hospital LOS compared to those who receive a reduced initial fluid volume.

The relation of breast cancer staging to screening protocol compliance: a computer simulation study.

A computer model based on relational database techniques was used to analyze the relationship between staging and population compliance to a breast cancer screening protocol. Stage distribution data permitted estimates of compliance to the protocol. This relationship followed the equation y=5.83e-2.44x where y was compliance and x was disease stage. Application of this equation to SEER and NCDB data estimated that the levels of compliance never exceeded 16 percent. Results indicated increasing clinical Stage IV disease as population compliance decreased. As the clinical staging increased there was increased sub-clinical Stage IV disease. With regular screening, simulation suggested that mortality would decrease.