Positive fluid balance and high mortality in paediatric patients with severe sepsis and septic shock
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Abstract
DOI: 10.1016/j.rcpe.2016.06.001
Introduction
In severe sepsis and septic shock one of the mainstays of treatment is the administration of intravenous fluids. However, the administration of excess fluids in sepsis may have deleterious effects.
Methods
A prospective observational cohort study was performed in order to determine if the fluid balance has a determining impact on mortality rate in a group of critically ill children with severe sepsis or septic shock.
Results
A total of 102 patients were included in the analysis. Severe sepsis was predominant in 61.8% of the cases. The mortality was 25.5%. The fluid balance was significantly higher at 48hours and 72hours in non-survivors, as well as the accumulated fluid balance in the first 72hours (1973±868ml vs. 1044±670ml, p<.0001).
Using a multivariate Cox regression model, a PELOD (Paediatric Logistic Organ Dysfunction) score of more than 20 points (HR=2.9; 1.7–11.4; p=.014), acute renal failure (HR=1.9; 95% CI; 1.1–3.8; p=.001), and fluid overload (HR=2.1; 95% CI; 1.3–8.2; p=.035) were identified as predictors of mortality at 28 days. A significantly increased risk of mortality in children with fluid overload (p=.002) is also observed in the survival curve using the Kaplan-Meier method.
Conclusions
The accumulated positive fluid balance in the first 72hours is associated with higher mortality in children with severe sepsis or septic shock. PELOD score, acute renal failure, and fluid overload increase the risk of mortality in these patients.
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