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• W4366996842 abstract "Objective: To investigate dose-response associations between fluid overload (FO) and hospital mortality in patients with sepsis. Methods: The current cohort study was prospective and multicenter. Data were derived from the China Critical Care Sepsis Trial, which was conducted from January 2013 to August 2014. Patients aged≥18 years who were admitted to intensive care units (ICUs) for at least 3 days were included. Fluid input/output, fluid balance, fluid overload (FO), and maximum FO (MFO) were calculated during the first 3 days of ICU admission. The patients were divided into three groups based on MFO values: MFO<5%L/kg, MFO 5%-10%L/kg, and MFO≥10% L/kg. Kaplan-Meier analysis was used to predict time to death in hospital in the three groups. Associations between MFO and in-hospital mortality were evaluated via multivariable Cox regression models with restricted cubic splines. Results: A total of 2 070 patients were included in the study, of which 1 339 were male and 731 were female, and the mean age was (62.6±17.9) years. Of 696 (33.6%) who died in hospital, 968 (46.8%) were in the MFO<5%L/kg group, 530 (25.6%) were in the MFO 5%-10%L/kg group, and 572 (27.6%) were in the MFO≥10%L/kg group. Deceased patients had significantly higher fluid input than surviving patients during the first 3 days [7 642.0 (2 874.3, 13 639.5) ml vs. 5 738.0 (1 489.0, 7 153.5)ml], and lower fluid output [4 086.0 (1 367.0, 6 354.5) ml vs. 6 130.0 (2 046.0, 11 762.0) ml]. The cumulative survival rates in the three groups gradually decreased with length of ICU stay, and they were 74.9% (725/968) in the MFO<5% L/kg group, 67.7% (359/530) in the MFO 5%-10%L/kg group, and 51.6% (295/572) in the MFO≥10%L/kg group. Compared with the MFO<5%L/kg group, the MFO≥10%L/kg group had a 49% increased risk of inhospital mortality (HR=1.49, 95%CI 1.28-1.73). For each 1% L/kg increase in MFO, the risk of in-hospital mortality increased by 7% (HR=1.07, 95% CI 1.05-1.09). There was aJ-shapednon-linear association between MFO and in-hospital mortality with a nadir of 4.1% L/kg. Conclusion: Higher and lower optimum fluid balance levels were associated with an increased risk of in-hospital mortality, as reflected by the observed J-shaped non-linear association between fluid overload and inhospital mortality.目的： 探讨液体超负荷与脓毒症患者住院死亡风险的剂量-反应关系。 方法： 多中心前瞻性队列研究。对象来源于2013年1月至2014年8月中国危重症患者脓毒症调查，选年龄≥18岁、入住ICU时间≥3 d的脓毒症患者，计算患者入组后前3天每日液体平衡、累积液体平衡、液体超负荷、最大液体超负荷（MFO）。根据MFO将研究对象分为MFO<5%L/kg者、MFO 5%~10%L/kg者及MFO≥10%L/kg者。采用Kaplan-Meier生存曲线比较不同MFO者住院累积存活率，采用带有限制性立方样条函数的多因素Cox回归模型分析MFO与脓毒症患者住院死亡风险的关系。 结果： 2 070例脓毒症患者纳入本研究，男性1 339例，女性731例，年龄（62.6±17.9）岁。1 374例（66.4%）患者存活，696例（33.6%）患者住院期间死亡。MFO<5%L/kg者 968例（46.8%），MFO 5%~10%L/kg 者530例（25.6%），MFO≥10% L/kg者572例（27.6%）。死亡者入ICU前3天的液体总入量［7 642.0（2 874.3，13 639.5）ml］高于存活者［5 738.0（1 489.0，7 153.5）ml］，液体总出量［4 086.0（1 367.0，6 354.5）ml］低于存活者［6 130.0（2 046.0，11 762.0）ml］。随着住ICU时间延长，患者累积生存率逐渐降低，MFO<5%者为74.9%（725/968），MFO 5%~10% L/kg者为67.7%（359/530），MFO≥10% L/kg者为51.6%（295/572），差异有统计学意义（P<0.001）。与MFO<5% L/kg者比，MFO≥10% L/kg者住院死亡风险增加（HR=1.49，95%CI 1.28~1.73）。MFO每增加1% L/kg，患者住院死亡风险增加7%（HR=1.07，95%CI 1.05~1.09）。MFO与住院死亡风险呈“J”型剂量-反应关系，MFO为4.1% L/kg，患者住院死亡风险最低。 结论： 液体超负荷与脓毒症患者住院死亡风险存在“J”型曲线关系，住院死亡风险最低点为MFO为4.1% L/kg，累积液体量高于或低于“最适”液体平衡，脓毒症患者死亡风险均会增加。." @default.
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• W4366996842 date "2023-05-01" @default.
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• W4366996842 title "[Dose-response association between fluid overload and hospital mortality in patients with sepsis]." @default.
• W4366996842 doi "https://doi.org/10.3760/cma.j.cn112138-20220516-00377" @default.
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