Association of Fluid Accumulation with Clinical Outcomes in Critically Ill Children with Severe Sepsis

Jiao Chen; Xiaozhong Li; Zhenjiang Bai; Fang Fang; Jun Hua; Ying Li; Jian Pan; Jian Wang; Xing Feng; Yanhong Li

doi:10.1371/journal.pone.0160093

Association of Fluid Accumulation with Clinical Outcomes in Critically Ill Children with Severe Sepsis

PLoS One. 2016 Jul 28;11(7):e0160093. doi: 10.1371/journal.pone.0160093. eCollection 2016.

Authors

Jiao Chen^{1

2}, Xiaozhong Li², Zhenjiang Bai¹, Fang Fang³, Jun Hua¹, Ying Li¹, Jian Pan³, Jian Wang³, Xing Feng⁴, Yanhong Li^{2

3}

Affiliations

¹ Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
² Department of Nephrology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
³ Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
⁴ Department of Neonatology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.

Abstract

Objective: To evaluate whether early and acquired daily fluid overload (FO), as well as fluctuations in fluid accumulation, were associated with adverse outcomes in critically ill children with severe sepsis.

Methods: This study enrolled 202 children in a pediatric intensive care unit (PICU) with severe sepsis. Early fluid overload was defined as ≥5% fluid accumulation occurring in the first 24 hours of PICU admission. The maximum daily fluid accumulation ≥5% occurring during the next 6 days in patients with at least 48 hours of PICU stay was defined as PICU-acquired daily fluid overload. The fluctuation in fluid accumulation was calculated as the difference between the maximum and the minimum daily fluid accumulation obtained during the first 7 days after admission.

Results: Of the 202 patients, 61 (30.2%) died during PICU stay. Among all patients, 41 (20.3%) experienced early fluid overload, including 9 with a FO ≥10%. Among patients with at least 48 hours of PICU stay (n = 154), 36 (23.4%) developed PICU-acquired daily fluid overload, including 2 with a FO ≥10%. Both early fluid overload (AOR = 1.20; 95% CI 1.08-1.33; P = 0.001; n = 202) and PICU-acquired daily fluid overload (AOR = 5.47 per log increase; 95% CI 1.15-25.96; P = 0.032; n = 154) were independent risk factors associated with mortality after adjusting for age, illness severity, etc. However, fluctuations in fluid accumulation were not associated with mortality after adjustment. Length of PICU stay increased with greater fluctuations in fluid accumulation in all patients with at least 48 hours of PICU stay (FO <5%, 5%-10% vs. ≥10%: 4 [3-8], 7 [4-11] vs. 10 [6-16] days; P <0.001; n = 154) and in survivors (4 [3-8], 7 [5-11] vs. 10 [5-15] days; P <0.001; n = 121). Early fluid overload achieved an area under-the-receiver-operating-characteristic curve of 0.74 (95% CI 0.65-0.82; P <0.001; n = 202) for predicting mortality in patients with severe sepsis, with a sensitivity of 67.2% and a specificity of 80.1% at the optimal cut-off value of 2.65%.

Conclusions: Both early and acquired daily fluid overload were independently associated with PICU mortality in children with severe sepsis.

MeSH terms

Child
Child, Preschool
Critical Illness
Female
Fluid Therapy / adverse effects*
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Male
Sepsis / physiopathology*
Sepsis / therapy*
Treatment Outcome

Grants and funding

This work was supported by grants from the National Natural Science Foundation of China (81370773), the Natural Science Foundation of Jiangsu Province (BK2012604), the Innovation Projects of Graduate Students in Colleges and Universities of Jiangsu Province, and the Key Research and Development Program of JiangSu province (Social Development, BE2016675). The funders had no role in study design, data collection and, decision to publish, or preparation of the manuscript.