Fluid balance and cardiac function in septic shock as predictors of hospital mortality

Micek, Scott T.; McEvoy, Colleen; McKenzie, Matthew; Hampton, Nicholas; Doherty, Joshua A.; Kollef, Marin H.

doi:10.1186/cc13072

Cited by 137 publications

(104 citation statements)

References 34 publications

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“…This interaction between sepsis and TTC is worthy of further mechanistic studies, similar to previous literature on septic cardiomyopathy 34. TTC shares many common attributes with septic cardiomyopathy, and one can speculate that it may share similar mechanisms and confer survival advantage in left ventricular systolic dysfunction in sepsis 35. Conversely, the lower mortality in TTC patients may have occurred because of ascertainment bias given that the sickest septic patients with TTC may have died before a diagnosis was made.…”

Section: Discussionsupporting

confidence: 71%

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

Vallabhajosyula

Deshmukh

Kashani

et al. 2018

JAHA

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BackgroundThere are limited data on the presentation of Takotsubo cardiomyopathy (TTC) in severe sepsis.Methods and ResultsThis was a retrospective cohort study using the National Inpatient Sample database (2007–2013) of all adults with severe sepsis. TTC was identified in patients with severe sepsis using previously validated administrative codes. The primary outcome was in‐hospital mortality, and secondary outcomes included resource utilization and discharge disposition. Regression analysis was performed for the entire cohort and a propensity‐matched sample. An exploratory analysis was performed for predictors of TTC incidence and mortality in TTC. During this 7‐year period, in 7.1‐million hospitalizations for severe sepsis, TTC was diagnosed in 10 746 (0.15%) admissions. TTC was noted more commonly in whites, females, and among 65‐ to 79‐year‐old individuals. TTC was independently associated with lower in‐hospital mortality in severe sepsis (odds ratio, 0.58; 95% confidence interval, 0.51–0.65). This association was more prominent in females (odds ratio, 0.51; 95% confidence interval, 0.44–0.59]) compared with males (odds ratio, 0.69; 95% confidence interval, 0.55–0.85]). Presentation in later years of the study period, middle‐age, female sex, and white race were independent predictors for the diagnosis of TTC. Age ≥80 years, black race, greater comorbidity, and multiorgan dysfunction were independently associated with higher in‐hospital mortality among TTC admissions.Conclusions TTC is observed with increasing frequency in severe sepsis and was associated with a significantly lower in‐hospital mortality compared with patients without TTC. Presentation in later years of the study period, middle age, female sex, and white race were independent predictors for the diagnosis of TTC in severe sepsis.

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Section: Discussionsupporting

confidence: 71%

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

Vallabhajosyula

Deshmukh

Kashani

et al. 2018

JAHA

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“…15 A study in adult populations also found that the FO is one of the risk factor for mortality in septic shock. 16 This high mortality rate in our study might be influenced by the disease severity of patient, as characterized by high initial PRISM III and PELOD scores, and the incidence of FO. The FO% was found to be significantly higher in the non-survival group and this might be rationalized by the lack of available hemodynamic monitoring tools in our setting, which could be utilized to guide fluid therapy and administration of inotrope agent.…”

Section: Discussionmentioning

confidence: 65%

Mortality rates in pediatric septic shock

Rusmawatiningtyas

Nurnaningsih

2017

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Background Septic shock remain a major cause of morbidity and mortality in children admitted to intensive care unit. Recent investigations from developed countries have reported mortality rates of 20-30%. Few studies had reported mortality rate for pediatric septic shock in intensive care setting from developing countries with limited resources. Objective To determine the current mortality rate for pediatric patients with septic shock in developing country. Methods A retrospective study was conducted in Pediatric Intensive Care Unit (PICU) in DR. Sardjito General Hospital. Medical record and chart were reviewed and recorded for diagnosis of septic shock, from November 1st, 2011 to June 30th, 2014. Results A database of all PICU admissions and cases with diagnoses of septic shock were reviewed. The final data consisted of 136 patients diagnosed with septic shock. Septic shock was defined as a clinical suspicious of sepsis, manifested by hyperthermia or hypothermia, and accompanied by hypoperfusion The overall mortality rate for the study cohort was 88.2%. The median age of patients was 16 months, with 52.2% male. Median initial PRISM III and PELOD scores were 10 and 22, respectively. The median length of PICU stay was 4 days. A total of 48.5% of the subjects were in need of crystalloid and colloid fluid in a median amount of 40 mL/kg. The median time required to complete the initial resuscitation was 60 minutes. Mechanical ventilator support in the first 24 hours was required in 79.4% of the cases. Fluid overload of > 10% (FO>10%) was found in 58.8% of the subjects. Conclusion The mortality rate in pediatric septic shock in our unit is very high. There is a higher incidence of fluid overload in non-survival group.

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“…Several studies in patients with sepsis have shown an association between positive fluid balance or volume overload and mortality, acute kidney injury (AKI), or need for fluid-related interventions (9)(10)(11)(12)(13).…”

Section: Methodsmentioning

confidence: 99%

Volume Overload: Prevalence, Risk Factors, and Functional Outcome in Survivors of Septic Shock

et al. 2015

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Rationale: Survivors of septic shock have impaired functional status. Volume overload is associated with poor outcomes in patients with septic shock, but the impact of volume overload on functional outcome and discharge destination of survivors is unknown.Objectives: This study describes patterns of fluid management both during and after septic shock. We examined factors associated with volume overload upon intensive care unit (ICU) discharge. We then examined associations between volume overload upon ICU discharge, mobility limitation, and discharge to a healthcare facility in septic shock survivors, with the hypothesis that volume overload is associated with increased odds of these outcomes. Methods:We retrospectively reviewed the medical records of 247 patients admitted with septic shock to an academic county hospital between June 2009 and April 2012 who survived to ICU discharge. We defined volume overload as a fluid balance expected to increase the subject's admission weight by 10%. Statistical methods included unadjusted analyses and multivariable logistic regression.Measurements and Main Results: Eighty-six percent of patients had a positive fluid balance, and 35% had volume overload upon ICU discharge. Factors associated with volume overload in unadjusted analyses included more severe illness, cirrhosis, blood transfusion during shock, and higher volumes of fluid administration both during and after shock. Blood transfusion during shock was independently associated with increased odds of volume overload (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.33-5.27; P = 0.01) after adjusting for preexisting conditions and severity of illness. Only 42% of patients received at least one dose of a diuretic during their hospitalization. Volume overload upon ICU discharge was independently associated with inability to ambulate upon hospital discharge (OR, 2.29; 95% CI, 1.24-4.25; P = 0.01) and, in patients admitted from home, upon discharge to a healthcare facility (OR, 2.34; 95% CI, 1.1-4.98; P = 0.03).Conclusions: Volume overload is independently associated with impaired mobility and discharge to a healthcare facility in survivors of septic shock. Prevention and treatment of volume overload in patients with septic shock warrants further investigation.

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Fluid balance and cardiac function in septic shock as predictors of hospital mortality

Cited by 137 publications

References 34 publications

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

Mortality rates in pediatric septic shock

Volume Overload: Prevalence, Risk Factors, and Functional Outcome in Survivors of Septic Shock

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