A Positive Fluid Balance in the First Week Was Associated With Increased Long-Term Mortality in Critically Ill Patients: A Retrospective Cohort Study

Wang, Tsai-Jung; Pai, Kai-Chih; Huang, Chun-Te; Wong, Li-Ting; Wang, Minn-Shyan; Lai, Chun-Ming; Chen, Cheng‐Hsu; Wu, Chieh‐Liang; Chao, Wen‐Cheng

doi:10.3389/fmed.2022.727103

Cited by 14 publications

(11 citation statements)

References 37 publications

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“…Another explanation for this effect could be the more inferior kidney function in critically ill patients, leading to acute kidney injury with subsequent fluid overload [ 51 , 52 ]. It is known that a higher fluid balance is associated with a more severe medical condition and an increased risk of mortality [ 53 , 54 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic and Rhythmologic Effects of Push-Dose Landiolol in Critical Care—A Retrospective Cross-Sectional Study

et al. 2023

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Background: The highly β1-selective beta-blocker Landiolol is known to facilitate efficient and safe rate control in non-compensatory tachycardia or dysrhythmia when administered continuously. However, efficacy and safety data of the also-available bolus formulation in critically ill patients are scarce. Methods: We conducted a retrospective cross-sectional study on a real-life cohort of critical care patients, who had been treated with push-dose Landiolol due to sudden-onset non-compensatory supraventricular tachycardia. Continuous hemodynamic data had been acquired via invasive blood pressure monitoring. Results: Thirty patients and 49 bolus applications were analyzed. Successful heart rate control was accomplished in 20 (41%) cases, rhythm control was achieved in 13 (27%) episodes, and 16 (33%) applications showed no effect. Overall, the heart rate was significantly lower (145 (130–150) vs. 105 (100–125) bpm, p < 0.001) in a 90 min post-application observational period in all subgroups. The median changes in blood pressure after the bolus application did not reach clinical significance. Compared with the ventilation settings before the bolus application, the respiratory settings including the required FiO2 after the bolus application did not differ significantly. No serious adverse events were seen. Conclusions: Push-dose Landiolol was safe and effective in critically ill ICU patients. No clinically relevant impact on blood pressure was noted.

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Section: Discussionmentioning

confidence: 99%

Hemodynamic and Rhythmologic Effects of Push-Dose Landiolol in Critical Care—A Retrospective Cross-Sectional Study

et al. 2023

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“…However, we are to our knowledge the first study to show the association of early fluid overload with poor long-term clinical outcomes at 1-year in pediatric heart transplant recipients, suggesting a possible pathophysiologic relationship that extends beyond the immediate perioperative period. ICU-related studies have shown an independent relationship between cumulative fluid balance and long-term mortality among critically ill patients [33,34]. Mechanistic studies have suggested prolonged fluid overload can lead to direct adverse effects that are inclusive of microvascular injury associated with tissue edema, endothelial dysfunction and shedding of the endothelial glycocalyx, and dysregulated immunity [4,[35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Early Postoperative Volume Overload is a Predictor of 1-Year Post-Transplant Mortality in Pediatric Heart Transplant Recipients

et al. 2023

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Fluid restriction and diuretic management are mainstays in the postoperative management of cardiac patients, at risk of volume overload and its deleterious effects on primary cardiac function and multi-organ systems. The importance of fluid homeostasis is further emphasized among orthotopic heart transplant recipients (OHT). We sought to investigate the relationship between postoperative volume overload, mortality, and allograft dysfunction among pediatric OHT recipients within 1-year of transplantation. This is a retrospective cohort study from a single pediatric OHT center. Children under 21 years undergoing cardiac transplantation between 2010 and 2018 were included. Cumulative fluid overload (cFO) was assessed as percent fluid accumulation adjusted for preoperative body weight. Greater than 10% cFO defined those with postoperative cFO and a comparison of postoperative cFO vs. no postoperative cFO (< 5%) is reported. 102 pediatric OHT recipients were included. Early cFO at 72 h post-OHT occurred in 14% and overall cFO at 1-week post-OHT occurred in 23% of patients. Risk factors for cFO included younger age, lower weight, and postoperative ECMO. Early cFO was associated with postoperative mortality at 1-year, OR 8.6 (95% CI 1.4, 51.6), p = 0.04, independent of age and weight. There was no significant relationship between cFO and allograft dysfunction, measured by rates of clinical rejection and cardiopulmonary filling pressures within 1-year of transplant. Early postoperative volume overload is prevalent and associated with increased risk of death at 1-year among pediatric OHT recipients. It may be an important postoperative marker of transplant survival, and this relationship warrants further clinical investigation.

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“…The critical care database at TCVGH was utilized to obtain essential clinical data, including demographic details, laboratory results, comorbidities evaluated using the modified Charlson Comorbidity Index (CCI), 17 Acute Physiology and Chronic Health Evaluation (APACHE) II score, presence of septic shock that was defined by diagnosis of sepsis, serum lactate level greater than 18.0 mg/dL as well as usage of vasopressors, receiving mechanical ventilation for more than 3 days, underwent renal replacement therapy, receiving blood transfusion during ICU admission, and cumulative fluid balance status during day 1–3, which have been identified as mortality-relevant factors in our previous investigation and other studies. 18 , 19 We also included the main organ dysfunction/failure as the covariate.…”

Section: Methodsmentioning

confidence: 99%

The Association Between Absolute Lymphocyte Count and Long-Term Mortality in Critically Ill Medical Patients: Propensity Score-Based Analyses

Hsiao,

Shen,

Wong

et al. 2023

IJGM

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Objective Absolute lymphocyte count (ALC) has been implicated with short-term outcomes in a number of diseases, and we aimed to investigate the association between week-one ALC and long-term mortality in patients who were admitted to the medical intensive care units (ICUs). Methods We enrolled patients who were admitted to the medical ICUs at the Taichung Veterans General Hospital, a referral centre located in central Taiwan, between 2015 and 2020 to conduct this retrospective cohort study. The outcome of interest was long-term all-cause mortality, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to determine the association. Furthermore, we employed propensity score-matching (PSM) and weighting techniques, consisting of inverse probability of treatment weighting (IPTW) and covariate balancing propensity score (CBPS), to confirm the association between ALC and mortality. Results A total of 5722 critically ill patients were enrolled, and the one-year mortality was 44.8%. The non-survivor group had a lower ALC (1549, 1027–2388 vs 1948, 1373–2743 counts/μL, p<0.01) compared with those in the survivor group. Cox regression showed that low ALC was independently associated with mortality (adjHR 1.091, 95% CI 1.050–1.134). Propensity score-based analyses demonstrated the robust association, with adjHRs in the original, PSM, IPTW, and CBPS populations of 1.327 (95% CI 1.224–1.438), 1.301 (95% CI 1.188–1.424), 1.292 (95% CI 1.186–1.407), and 1.297 (95% CI 1.191–1.412), respectively. Sensitivity analyses further showed that the association between low ALC and mortality existed in a dose-response manner. Conclusion We found that low ALC was associated with long-term mortality in critically ill patients; further studies are warranted to validate and translate these findings into clinical utility.

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A Positive Fluid Balance in the First Week Was Associated With Increased Long-Term Mortality in Critically Ill Patients: A Retrospective Cohort Study

Cited by 14 publications

References 37 publications

Hemodynamic and Rhythmologic Effects of Push-Dose Landiolol in Critical Care—A Retrospective Cross-Sectional Study

Hemodynamic and Rhythmologic Effects of Push-Dose Landiolol in Critical Care—A Retrospective Cross-Sectional Study

Early Postoperative Volume Overload is a Predictor of 1-Year Post-Transplant Mortality in Pediatric Heart Transplant Recipients

The Association Between Absolute Lymphocyte Count and Long-Term Mortality in Critically Ill Medical Patients: Propensity Score-Based Analyses

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