Association between fluid overload and SOFA score kinetics in septic shock patients: a retrospective multicenter study

被引:19
作者
Chapalain, Xavier [1 ,2 ,7 ,8 ]
Vermeersch, Veronique [1 ,2 ,7 ,8 ]
Egreteau, Pierre-Yves [5 ]
Prat, Gwenael [4 ]
Alavi, Zarrin [6 ]
Vicaut, Eric [3 ]
Huet, Olivier [1 ,2 ,7 ,8 ]
机构
[1] CHRU Brest, Hop Cavale Blanche, Dept Anesthesiol, Blvd Tanguy Prigent, Brest, France
[2] CHRU Brest, Hop Cavale Blanche, Intens Care Unit, Blvd Tanguy Prigent, Brest, France
[3] Univ Paris Diderot, Hop Fernand Widal, AP HP, Unite Rech Clin, Paris, France
[4] CHRU Brest, Dept Med ICU, Blvd Tanguy Prigent, Paris, France
[5] CH Morlaix, Dept Intens Care Med, Rue Kersaint Gilly, Morlaix, France
[6] CHRU Brest, Hop Cavale Blanche, INSERM CIC 1412, Blvd Tanguy Prigent, Paris, France
[7] ATLANREA Clin Trial Grp, Paris, France
[8] Univ Bretagne Occidentale, UFR Med, Brest, France
关键词
Sepsis; Septic shock; Fluid therapy; Water-electrolyte balance; Intensive care unit; CAMPAIGN INTERNATIONAL GUIDELINES; CRITICALLY-ILL; SEVERE SEPSIS; MANAGEMENT; RESUSCITATION; OUTCOMES; BALANCE; VOLUME; ADULTS; RISK;
D O I
10.1186/s40560-019-0394-0
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background Fluid infusion represents one of the cornerstones of resuscitation therapies in order to increase oxygen delivery during septic shock. Fluid overload as a consequence of excessive fluid administration seems to be linked to worse long-term outcome. However, its immediate effect on patient's clinical state is poorly described. The goal of this study was to assess the impact of FO on SOFA score kinetics as a surrogate marker of organ dysfunction from day 0 to day 5. Material and methods Retrospective, multicenter, investigator-initiated study. All adult patients (> 18 years old) admitted from January 2012 to April 2017 in one of the three ICUs for septic shock, secondary to peritonitis or pulmonary infection and mechanically ventilated, were included. Univariate analysis was performed with Student's t and chi-square test, for continuous and categorical variables, respectively. A multivariate linear regression model evaluated the impact of FO on delta SOFA score from day 0 to day 5. Secondly, a multivariate mixed-model accounting for repeated measures analyzed the impact of FO on SOFA score kinetics. Results One hundred twenty-nine patients met the inclusion criteria and were assigned into FO and no FO groups. FO occurred in 39% of the patients. The difference between SOFA score at day 0 and day 5 was more than twofold higher in the no FO group than in the FO group with a difference of 2.37 between the two groups (4.52 vs. 2.15; p = 0.001). Cumulative fluid intake at day 5 was higher in the FO group (2738 vs. 8715 ml, p < 0.001). In multivariate analysis, FO was associated with delta SOFA score: aRR = 0.15 (95% CI 0.03-0.63; p = 0.009). In mixed model, the regression coefficient for fluid overload status (r(2) = 1.16; p = 0.014) indicated that the slope for SOFA score kinetic was less pronounced for patients with FO than for patients without FO. Conclusions FO patients had a more prolonged multi-organ failure according to SOFA score kinetics during septic shock from resuscitation phase to day 5.
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