Evaluating the Impact of Positive Fluid Balance on Mortality and Length of Stay in Septic Shock Patients

Abstract

Background Sepsis is accountable for major morbidity and mortality in patients with critical illnesses. The present research was undertaken to evaluate the correlation between fluid balance during hospitalizations and patient outcomes in patients with sepsis. Methods An observational study was undertaken at the Critical Care Department, Shifa International Hospital, Islamabad, Pakistan between December 2021 to April 2022. The patients included were over the age of 17 years, with a proven diagnosis of infection. These patients either had positive bacterial cultures, suffered from organ failure secondary to sepsis, or had clinically evident signs of infection. Patients who were discharged during the period of study were eliminated from the study population. All patients were informed of the process and signed consent was obtained. Basic demographic information was recorded, which included the existence of any comorbid conditions, organ failure, medication use, or infection history. The severity of critical illness was determined for every single patient along with organ damage. The final patient outcome was recorded as in-hospital mortality. Results A total of 307 patients were included in the study with a total of 165 (53.75%) male patients. The overall mortality rate was 39.74%. The mean length of hospitalization was 17.42 ± 8.3 days. A high SOFA score was significantly associated with quartile 4 with a mean score of 14.1 (p < 0.001). Similarly, a significantly higher APACHE score was found in patients in quartile 4 (p < 0.001) thus indicating a relationship between severity of illness and positive fluid balance. Upon further assessment, it was found that the 28th day and 90th day were significantly greater in quartile 4 in comparison to other quartiles. Similarly, the overall length of stays in the hospital and in the ICU were also significantly associated with greater fluid balance (p < 0.001). Conclusion In our study, it was concluded that monitoring fluid balance in critically ill patients is very important. The highest 28-day and 90-day mortality were seen in patients with the greatest positive fluid balance. However, the cause of high mortality in this cohort could be multifactorial; therefore, the relationship of positive fluid balance with patient outcome remains debatable.

Keywords: apache; emergency critical care; intensive care unit stay; severe sepsis; sofa.