Association between fluid overload and mortality in children with sepsis: a systematic review and meta-analysis

Jaime Fernández-Sarmiento; Marco Fidel Sierra-Zuñiga; María Paula Salazar González; Natalia Lucena; Vanessa Soares Lanziotti; Sergio Agudelo

doi:10.1136/bmjpo-2023-002094

Association between fluid overload and mortality in children with sepsis: a systematic review and meta-analysis

BMJ Paediatr Open. 2023 Nov;7(1):e002094. doi: 10.1136/bmjpo-2023-002094.

Authors

Jaime Fernández-Sarmiento^{1

2}, Marco Fidel Sierra-Zuñiga^{3

2}, María Paula Salazar González^{3

2}, Natalia Lucena^{3

2}, Vanessa Soares Lanziotti⁴, Sergio Agudelo²

Affiliations

¹ Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia jaimefe@unisabana.edu.co.
² Department of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Bogotá, Colombia.
³ Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
⁴ Pediatric Intensive Care Unit & Research and Education Division, Pediatric Institute of Federal University of Rio de Janeiro (IPPMG-UFRJ), Rio de Janeiro, Brazil.

Abstract

Background: Sepsis is one of the main causes of morbidity and mortality worldwide. Fluid resuscitation is among the most common interventions and is associated with fluid overload (FO) in some patients. The objective of this systematic review and meta-analysis was to summarise the available evidence on the association between FO and morbimortality in children with sepsis.

Methods: A systematic search was carried out in PubMed/Medline, Embase, Cochrane and Google Scholar up to December 2022 (PROSPERO 408148), including studies in children with sepsis which reported more than 10% FO 24 hours after admission to intensive care. The risk of bias was assessed using the Newcastle-Ottawa scale. Heterogeneity was assessed using I², considering it absent if <25% and high if >75%. A sensitivity analysis was run to explore the impact of the methodological quality on the size of the effect. Mantel-Haenszel's model of random effects was used for the analysis. The primary outcome was to determine the risk of mortality associated with FO and the secondary outcomes were the need for mechanical ventilation (MV), multiple organ dysfunction syndrome (MODS) and length of hospital stay associated with FO.

Results: A total of 9 studies (2312 patients) were included, all of which were observational. Children with FO had a higher mortality than patients without overload (46% vs 26%; OR 5.06; 95% CI 1.77 to 14.48; p<0.01). We found no association between %FO and the risk of MODS (OR: 0.97; 95% CI 0.13 to 7.12; p=0.98). Children with FO required MV more often (83% vs 47%; OR: 4.78; 95% CI 2.51 to 9.11; p<0.01) and had a longer hospital stay (8 days (RIQ 6.5-13.2) vs 7 days (RIQ 6.1-11.5); p<0.01).

Conclusion: In children with sepsis, more than 10% FO 24 hours after intensive care admission is associated with higher mortality, the need for MV and length of hospital stay.

Keywords: Infant; Intensive Care; Mortality; Resuscitation.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Child
Fluid Therapy / adverse effects
Humans
Intensive Care Units, Pediatric
Length of Stay
Sepsis* / therapy
Water-Electrolyte Imbalance*