Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock

Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock

Author Vilaca de Oliveira, Fernando Saes Autor UNIFESP Google Scholar
Resende Freitas, Flavio Geraldo Autor UNIFESP Google Scholar
Ferreira, Elaine Maria Autor UNIFESP Google Scholar
Castro, Isac de Autor UNIFESP Google Scholar
Bafi, Antonio Tonete Autor UNIFESP Google Scholar
Pontes de Azevedo, Luciano Cesar Autor UNIFESP Google Scholar
Machado, Flavia Ribeiro Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Purpose: the purpose of this study is to assess whether late positive fluid balances are associated with acute kidney injury and mortality in severe sepsis and septic shock.Methods: in this retrospective study, fluid balances were calculated at 3 different time points: the onset of organ dysfunction attributed to sepsis, sepsis diagnosis, and vasopressors initiation. Data were analyzed in logistic regression models for mortality and acute kidney injury as outcomes.Results: We included 116 patients. A RIFLE score F, diuresis less than 0.9 L from the second day after the first organ dysfunction, and fluid balance more than 3 L between the 24th and the 48th hour after diagnosis were independently associated with higher mortality, whereas in the subgroup with shock, only the latter parameter and diuresis less than 0.85 L on the first day of shock were independent risk factors. After adjusting for age, creatinine more than 1.2 mg/dL, a nonrenal Sequential Organ Failure Assessment greater than or equal to 7.5 on the first day and urine output less than 1.3 L on the first day after organ dysfunction were independent risk factors for RIFLE F. No relationship was found between fluid balance and acute kidney injury.Conclusion: Late positive fluid balance is an independent risk factor for mortality in severe sepsis. Positive fluid balances are not associated with either protection against or risk for acute kidney injury. (C) 2014 Elsevier Inc. All rights reserved.
Keywords Severe sepsis
Fluid balance
Mortality
Language English
Date 2015-02-01
Published in Journal of Critical Care. Philadelphia: W B Saunders Co-Elsevier Inc, v. 30, n. 1, p. 97-101, 2015.
ISSN 0883-9441 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 97-101
Origin http://dx.doi.org/10.1016/j.jcrc.2014.09.002
Access rights Closed access
Type Article
Web of Science ID WOS:000346238900016
URI http://repositorio.unifesp.br/handle/11600/38700

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