Fluid Overload

O’Connor, Michael; Prowle, John R.

doi:10.1016/j.ccc.2015.06.013

Cited by 119 publications

(98 citation statements)

References 114 publications

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“…Loss of normal glycocalyx and endothelial integrity secondary to cytotoxic injury causes a markedly disrupted systemic fluid balance leading to a deleterious cycle of intravascular fluid loss, interstitial edema, impaired vascular tone, and plasma protein loss. 4,6 This is congruent with our finding that patients with normal albumin levels prior to allo-HCT had a reduced risk of FO. These events likely influence the use and overuse of IV fluids that may worsen excessive FO.…”

Section: Discussionsupporting

confidence: 87%

“…5 FO in critically ill patients exerts its effects through disruption of organ architecture, vascular drainage, and oxygen perfusion secondary to interstitial edema. 6 FO is common among patients during the early post allogeneic hematopoietic cell transplantation (allo-HCT) period, even in the absence of sepsis or critical illness. Moreover, its influence on outcomes after allo-HCT has been poorly understood until recently.…”

Section: Introductionmentioning

confidence: 99%

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Early Fluid Overload Is Associated with an Increased Risk of Nonrelapse Mortality after Ex Vivo CD34-Selected Allogeneic Hematopoietic Cell Transplantation

Rondon-Clavo

Scordo

Hilden

et al. 2018

Biology of Blood and Marrow Transplantation

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In a recently published and validated definition of fluid overload (FO), grade ≥ 2 FO was significantly associated with an increased risk of nonrelapse mortality (NRM) after unmodified and haploidentical allogeneic hematopoietic cell transplantation (allo-HCT) using calcineurin inhibitor (CNI)-based graft-versus-host disease (GVHD) prophylaxis. We evaluated the effect of FO on outcomes in 169 patients undergoing myeloablative-conditioned ex vivo CD34 selected allo-HCT using the same grading scale. Thirty patients (17.8%) had grade ≥ 2 FO within the 30 days after ex vivo CD34 selected allo-HCT with a median onset at day 11 (range, -8 to 28). Age ≥ 55 years (odds ratio, 3.43; P = .005) and chemotherapy-based conditioning (odds ratio, 3.89; P = .007) were associated with an increased risk of grade ≥ 2 FO. Patients with early grade ≥ 2 FO had a significantly higher NRM when compared with patients with grade < 2 FO (24.1% versus 3.6% at day 100, P = .01). The HCT-specific comorbidity index (HCT-CI) ≥ 3, FEV < 80, adjusted DL < 80, and HLA mismatch were associated with an increased risk of NRM, whereas total body irradiation-based conditioning was associated with a reduced risk of NRM. In a multivariate analysis grade ≥ 2 FO was associated with increased NRM after adjusting for HCT-CI and HLA match (hazard ratio, 2.3; P = .014). There was a trend toward inferior relapse-free survival in patients with grade ≥ 2 FO compared with patients with grade < 2 FO, 62% versus 72% at 1 year (P = .07), and a trend toward inferior overall survival, 69% versus 79% at 1 year (P = 0.06), respectively. Our findings show that FO should be routinely assessed to identify patients at risk for NRM. Despite a CNI-free allo-HCT platform, regimen-related tissue and endothelial injury leads to FO in susceptible patients. FO is a highly relevant post-HCT toxicity that requires further inquiry.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Early Fluid Overload Is Associated with an Increased Risk of Nonrelapse Mortality after Ex Vivo CD34-Selected Allogeneic Hematopoietic Cell Transplantation

Rondon-Clavo

Scordo

Hilden

et al. 2018

Biology of Blood and Marrow Transplantation

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“…This interstitial edema may mediate toxic effects in multiple organs. The capillary vascular endothelium may play an important role in the balance between extracellular and intravascular fluids, 13 which could make FO part of a spectrum of endothelial damage disorders that includes sinusoidal obstructive syndrome, thrombotic microangiopathy, and idiopathic pneumonia syndrome.…”

Section: Discussionmentioning

confidence: 99%

Impact of Fluid Overload as New Toxicity Category on Hematopoietic Stem Cell Transplantation Outcomes

Rondón

Saliba

Chen

et al. 2017

Biology of Blood and Marrow Transplantation

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Fluid overload (FO) is commonly seen during hospitalization for allogeneic hematopoietic stem-cell transplantation (AHSCT). We hypothesized that FO is associated with transplant outcomes and evaluated this complication in two cohorts of patients and graded based on post-transplant weight gain, symptoms, and need for treatment, and was scored in real time by an independent team. The first cohort (study cohort) underwent haploidentical transplantation for hematologic malignancies (N=145) following a melphalan-based conditioning regimen. In univariate analysis, factors associated with Day 100 non-relapse mortality (NRM) were FO Grade ≥2 (HR=15, CI 4.2–55, p<0.001), creatinine >1 mg/dL (HR=4.7, CI 1.6–14, p=0.005), and age >55 years (HR=4.5, CI 1.5–13, p=0.008). In multivariate analysis, factors associated with Day 100 NRM were FO Grade ≥2 (HR=13.1, CI 3.4–50, p<0.001) and creatinine >1 mg/dL at transplant admission (HR=3.5, CI 1.1–11, p=0.03). These findings were verified in a separate cohort (validation cohort) of patients with acute myeloid leukemia/myelodysplastic syndrome who underwent HLA-matched transplant (N=449) with busulfan-based conditioning. In multivariate analysis, factors associated with Day 100 NRM were FO Grade ≥2 (HR=34, CI 7.2–158, p<0.001) and, in patients with FO Grade <2, advanced disease status (HR=5, CI 1.1–22, p=0.03). A higher NRM translated to significantly poorer 1-year overall survival rates for patients with FO ≥2 than for patients without FO, 70% vs. 42% (p<0.001) in the study cohort and 64% vs. 38% (p<0.001) in the validation cohort. In conclusion, FO Grade ≥2 is strongly associated with higher NRM and shorter survival and should be considered an important prognostic factor in transplantation.

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“…The resulting fluid overload, with thresholds of 10% excess from the admission weight, is associated with an incremental risk of mortality in patients with and without AKI [79]. Fluid overloaded patients have an increased risk of AKI [80, 81], and there is reduced renal recovery from AKI [82]. Several studies have shown that both the magnitude and persistence of fluid overload are associated with worse outcomes, suggesting that prevention and correction of fluid accumulation are modifiable risk factors to improve survival.…”

Section: Rrt In Severe Aki: An Overviewmentioning

confidence: 99%

Acute kidney injury in the ICU: from injury to recovery: reports from the 5th Paris International Conference

Bellomo

Ronco

Mehta

et al. 2017

Ann. Intensive Care

123

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The French Intensive Care Society organized its yearly Paris International Conference in intensive care on June 18–19, 2015. The main purpose of this meeting is to gather the best experts in the field in order to provide the highest quality update on a chosen topic. In 2015, the selected theme was: “Acute Renal Failure in the ICU: from injury to recovery.” The conference program covered multiple aspects of renal failure, including epidemiology, diagnosis, treatment and kidney support system, prognosis and recovery together with acute renal failure in specific settings. The present report provides a summary of every presentation including the key message and references and is structured in eight sections: (a) diagnosis and evaluation, (b) old and new diagnosis tools, (c) old and new treatments, (d) renal replacement therapy and management, (e) acute renal failure witness of other conditions, (f) prognosis and recovery, (g) extracorporeal epuration beyond the kidney, (h) the use of biomarkers in clinical practice http://www.srlf.org/5th-paris-international-conference-jeudi-18-et-vendredi-19-juin-2015/.

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Fluid Overload

Cited by 119 publications

References 114 publications

Early Fluid Overload Is Associated with an Increased Risk of Nonrelapse Mortality after Ex Vivo CD34-Selected Allogeneic Hematopoietic Cell Transplantation

Early Fluid Overload Is Associated with an Increased Risk of Nonrelapse Mortality after Ex Vivo CD34-Selected Allogeneic Hematopoietic Cell Transplantation

Impact of Fluid Overload as New Toxicity Category on Hematopoietic Stem Cell Transplantation Outcomes

Acute kidney injury in the ICU: from injury to recovery: reports from the 5th Paris International Conference

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