Early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT

Abstract Fluid overload (FO) with coincident acute kidney injury has been associated with increased mortality. However, it is unclear whether FO is an independent determinant of mortality for disease severity. We aimed to explore whether the development of fluid balance (FB) during the first 72 h of...

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Autores principales:	Panu Uusalo, Tapio Hellman, Eliisa Löyttyniemi, Julia Peltoniemi, Mikko J. Järvisalo
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/bb23a6db2c0b4f33952c0f6bc62bfab3
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spelling	oai:doaj.org-article:bb23a6db2c0b4f33952c0f6bc62bfab32021-12-02T18:33:55ZEarly restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT10.1038/s41598-021-97888-y2045-2322https://doaj.org/article/bb23a6db2c0b4f33952c0f6bc62bfab32021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-97888-yhttps://doaj.org/toc/2045-2322Abstract Fluid overload (FO) with coincident acute kidney injury has been associated with increased mortality. However, it is unclear whether FO is an independent determinant of mortality for disease severity. We aimed to explore whether the development of fluid balance (FB) during the first 72 h of continuous renal replacement therapy (CRRT) is independently associated with hospital mortality. All patients admitted to a single centre ICU requiring CRRT for at least 24 h between years 2010–2019 were included. Extracted data included patient demographics and clinical parameters including daily cumulative fluid balance (FBcum), lactate, SOFA score and vasoactive requirement at the initiation and during the first 72 h of CRRT. 399 patients were included in the analysis. Hospital survivors had a significantly lower FBcum at CRRT initiation compared to non-survivors (median 1382 versus 3265 ml; p = 0.003). Hourly fluid balance per bodyweight (FBnet) was lower in survivors at 0–24, 24–48 and 48–72 h after initiation of CRRT (p < 0.008 for all comparisons). In the survival analysis (analyzed with counting process model) significant time-dependent explanatory variables for hospital mortality were FBnet (per ml/kg/h: HR: 1.319, 95% CI 1.038–1.677, p = 0.02), lactate (HR: 1.086, 95% CI 1.030–1.145, p = 0.002) and SOFA score (per ml/kg/h: HR: 1.084, 95% CI 1.025–1.146, p = 0.005) during the first 72 h of CRRT. Even after careful adjustment for repeated measures of disease severity, FBnet during the first 72 h of CRRT remains independently associated with hospital mortality, in critically ill patients with AKI.Panu UusaloTapio HellmanEliisa LöyttyniemiJulia PeltoniemiMikko J. JärvisaloNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Panu Uusalo Tapio Hellman Eliisa Löyttyniemi Julia Peltoniemi Mikko J. Järvisalo Early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT
description	Abstract Fluid overload (FO) with coincident acute kidney injury has been associated with increased mortality. However, it is unclear whether FO is an independent determinant of mortality for disease severity. We aimed to explore whether the development of fluid balance (FB) during the first 72 h of continuous renal replacement therapy (CRRT) is independently associated with hospital mortality. All patients admitted to a single centre ICU requiring CRRT for at least 24 h between years 2010–2019 were included. Extracted data included patient demographics and clinical parameters including daily cumulative fluid balance (FBcum), lactate, SOFA score and vasoactive requirement at the initiation and during the first 72 h of CRRT. 399 patients were included in the analysis. Hospital survivors had a significantly lower FBcum at CRRT initiation compared to non-survivors (median 1382 versus 3265 ml; p = 0.003). Hourly fluid balance per bodyweight (FBnet) was lower in survivors at 0–24, 24–48 and 48–72 h after initiation of CRRT (p < 0.008 for all comparisons). In the survival analysis (analyzed with counting process model) significant time-dependent explanatory variables for hospital mortality were FBnet (per ml/kg/h: HR: 1.319, 95% CI 1.038–1.677, p = 0.02), lactate (HR: 1.086, 95% CI 1.030–1.145, p = 0.002) and SOFA score (per ml/kg/h: HR: 1.084, 95% CI 1.025–1.146, p = 0.005) during the first 72 h of CRRT. Even after careful adjustment for repeated measures of disease severity, FBnet during the first 72 h of CRRT remains independently associated with hospital mortality, in critically ill patients with AKI.
format	article
author	Panu Uusalo Tapio Hellman Eliisa Löyttyniemi Julia Peltoniemi Mikko J. Järvisalo
author_facet	Panu Uusalo Tapio Hellman Eliisa Löyttyniemi Julia Peltoniemi Mikko J. Järvisalo
author_sort	Panu Uusalo
title	Early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT
title_short	Early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT
title_full	Early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT
title_fullStr	Early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT
title_full_unstemmed	Early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT
title_sort	early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on crrt
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/bb23a6db2c0b4f33952c0f6bc62bfab3
work_keys_str_mv	AT panuuusalo earlyrestrictivefluidbalanceisassociatedwithlowerhospitalmortalityindependentofacutediseaseseverityincriticallyillpatientsoncrrt AT tapiohellman earlyrestrictivefluidbalanceisassociatedwithlowerhospitalmortalityindependentofacutediseaseseverityincriticallyillpatientsoncrrt AT eliisaloyttyniemi earlyrestrictivefluidbalanceisassociatedwithlowerhospitalmortalityindependentofacutediseaseseverityincriticallyillpatientsoncrrt AT juliapeltoniemi earlyrestrictivefluidbalanceisassociatedwithlowerhospitalmortalityindependentofacutediseaseseverityincriticallyillpatientsoncrrt AT mikkojjarvisalo earlyrestrictivefluidbalanceisassociatedwithlowerhospitalmortalityindependentofacutediseaseseverityincriticallyillpatientsoncrrt
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Early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT

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