Association between intravenous fluid resuscitation and outcome among patients with suspected infection and sepsis: A retrospective cohort study

Gladis Kabil; Sophie Liang; Anthony Delaney; Stephen Macdonald; Kelly Thompson; Aldo Saavedra; Carl Suster; Michelle Moscova; Stephen McNally; Steven Frost; Deborah Hatcher; Amith Shetty

doi:10.1111/1742-6723.13893

Association between intravenous fluid resuscitation and outcome among patients with suspected infection and sepsis: A retrospective cohort study

Emerg Med Australas. 2022 Jun;34(3):361-369. doi: 10.1111/1742-6723.13893. Epub 2021 Nov 12.

Authors

Gladis Kabil^{1

2}, Sophie Liang³, Anthony Delaney⁴, Stephen Macdonald^{5

6}, Kelly Thompson⁷, Aldo Saavedra⁸, Carl Suster⁸, Michelle Moscova⁹, Stephen McNally¹, Steven Frost¹, Deborah Hatcher¹, Amith Shetty^{10

11}

Affiliations

¹ School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.
² Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
³ Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
⁴ The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.
⁵ Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.
⁶ Emergency Medicine, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia.
⁷ Critical Care and Trauma Division, The George Institute for Global Health, Sydney, New South Wales, Australia.
⁸ Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia.
⁹ Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia.
¹⁰ Westmead Hospital, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
¹¹ Patient Experience System Performance Support Division, NSW Ministry of Health, Sydney, New South Wales, Australia.

PMID: 34773387
DOI: 10.1111/1742-6723.13893

Abstract

Objective: To investigate the association between timing and volume of intravenous fluids administered to ED patients with suspected infection and all-cause in-hospital mortality.

Methods: Retrospective cohort study of ED presentations at four metropolitan hospitals in Sydney, Australia, between October 2018 and May 2019. Patients over 16 years of age with suspected infection who received intravenous fluids within 24 h of presentation were included.

Results: During the study period, 7533 patients with suspected infection received intravenous fluids. Of these, 1996 (26.5%) and 231 (3.1%) had suspected sepsis and septic shock, respectively. Each 1000 mL increase in intravenous fluids administered was associated with a reduction in risk of in-hospital mortality (adjusted odds ratio [AOR] 0.87, 95% confidence interval [CI] 0.76-0.99). This association was stronger in patients with septic shock (AOR 0.66, 95% CI 0.49-0.89), and those admitted to intensive care unit (ICU) (AOR 0.74, 95% CI 0.56-0.96). Patients with suspected sepsis and septic shock who received a total volume of >3600 mL had lower in-hospital mortality (AOR 0.44, 95% CI 0.22-0.91; AOR 0.16, 95% CI 0.05-0.57) compared to those administered <3600 mL within the first 24 h of presenting to the ED. There was no association between the time of initiation of fluids and in-hospital mortality among survivors and non-survivors (2.3 vs 2.5 h, P = 0.50).

Conclusion: We observed a reduction in risk of in-hospital mortality for each 1000 mL increase in intravenous fluids administered in patients with septic shock or admitted to ICU suggesting illness severity to be a likely effect modifier.

Keywords: emergency service; fluid resuscitation; sepsis; septic shock.

MeSH terms

Emergency Service, Hospital
Fluid Therapy
Hospital Mortality
Humans
Resuscitation
Retrospective Studies
Sepsis* / drug therapy
Shock, Septic* / drug therapy