Association of fluid balance trajectories with clinical outcomes in patients with septic shock:A prospective multicenter cohort study

作     者：Mei-Ping Wang Li Jiang Bo Zhu Bin Du Wen Li Yan He Xiu-Ming Xi China Critical Care Sepsis Trial(CCCST)workgroup Mei-Ping Wang;Li Jiang;Bo Zhu;Bin Du;Wen Li;Yan He;Xiu-Ming Xi;China Critical Care Sepsis Trial (CCCST)workgroup

作者机构：Department of Epidemiology and Health StatisticsSchool of Public HealthCapital Medical UniversityNo.10XitoutiaoYou’anmenBeijingFengtai DistrictChina Department of Critical Care MedicineFuxing HospitalCapital Medical UniversityNo.20Street FuxingmenwaiBeijingXicheng DistrictChina Department of Critical Care MedicineXuanwu HospitalCapital Medical UniversityBeijing 100053China Medical Intensive Care UnitPeking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijing 100730China 

出 版 物：《Military Medical Research》 (军事医学研究（英文版）)

年 卷 期：2021年第8卷第3期

页      面：395-404页

核心收录：

学科分类：100218[医学-急诊医学] 1002[医学-临床医学] 1010[医学-医学技术（可授医学、理学学位）] 10[医学] 

基　　金：supported by the National Science and Technology Supporting Plan of the Ministry of Science and Technology of China(2012BAI11B05) 

主　　题：Septic shock Fluid overload Group-based trajectory model Clinical outcomes 

摘      要：Background:Septic shock has a high incidence and mortality rate in Intensive Care Units(ICUs).Earlier intravenous fluid resuscitation can significantly improve outcomes in septic patients but easily leads to fluid overload(FO),which is associated with poor clinical outcomes.A single point value of fluid cannot provide enough fluid *** aim of this study was to investigate the impact of fluid balance(FB)latent trajectories on clinical outcomes in septic ***:Patients were diagnosed with septic shock during the first 48 h,and sequential fluid data for the first 3 days of ICU admission were included.A group-based trajectory model(GBTM)which is designed to identify groups of individuals following similar developmental trajectories was used to identify latent subgroups of individuals following a similar progression of *** primary outcomes were hospital mortality,organ dysfunction,major adverse kidney events(MAKE)and severe respiratory adverse events(SRAE).We used multivariable Cox or logistic regression analysis to assess the association between FB trajectories and clinical ***:Nine hundred eighty-six patients met the inclusion criteria and were assigned to GBTM analysis,and three latent FB trajectories were detected.64(6.5%),841(85.3%),and 81(8.2%)patients were identified to have decreased,low,and high FB,*** with low FB,high FB was associated with increased hospital mortality[hazard ratio(HR)=1.63,95%CI 1.22–2.17],organ dysfunction[odds ratio(OR)=2.18,95%CI 1.22–3.42],MAKE(OR=1.80,95%CI 1.04–2.63)and SRAE(OR=2.33,95%CI 1.46–3.71),and decreasing FB was significantly associated with decreased MAKE(OR=0.46,95%CI 0.29–0.79)after adjustment for potential ***:Latent subgroups of septic patients followed a similar FB *** latent fluid trajectories were associated with clinical *** decreasing FB trajectory was associated with a decreased risk of hospital mortality and MAKE.