Optimal fluid resuscitation targets in septic patients with acutely decompensated heart failure.

IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Jie Weng, Zhe Xu, Jiaze Song, Chen Liu, Haijuan Jin, Qianhui Cheng, Xiaoming Zhou, Dongyuan He, Jingwen Yang, Jiaying Lin, Liang Wang, Chan Chen, Zhiyi Wang
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引用次数: 0

Abstract

Background: To determine the optimal fluid resuscitation volume in septic patients with acutely decompensated heart failure (ADHF).

Methods: Septic patients with ADHF were identified from a tertiary urban medical center. The generalized additive models were used to explore the association between fluid resuscitation volume and endpoints, and the initial 3 h fluid resuscitation volume was divided into four groups according to this model: < 10 mL/kg group, ≥ 10 to ≤ 15 mL/kg group, > 15 to ≤ 20 mL/kg group, and > 20 mL/kg group. Logistic and Cox regression models were employed to explore the association between resuscitation volume and primary endpoint, in-hospital mortality, as well as secondary endpoints including 30-day mortality, 1-year mortality, invasive ventilation, and ICU admission.

Results: A total of 598 septic patients with a well-documented history of HF were enrolled in the study; 405 patients (68.8%) had sepsis-induced hypoperfusion. Patients with NYHA functional class III and IV were 494 (83.9%) and 22 (3.74%), respectively. Resuscitation volumes above 20 mL/kg (OR 3.19, 95% CI 1.31-8.15) or below 10 mL/kg (OR 2.33, 95% CI 1.14-5.20) significantly increased the risk of in-hospital mortality in septic patients, while resuscitation volumes between 15 and 20 mL/kg were not associated with the risk of in-hospital death in septic patients (OR 1.79, 95% CI 0.68-4.81). In the multivariable Cox models, the effect of resuscitation volume on 30-day and 1-year mortality in septic patients was similar to the effect on in-hospital mortality. Resuscitation volume exceeds 15 mL/kg significantly increased the risk of tracheal intubation, while fluid resuscitation volume was not associated with ICU admission in the septic patients. In septic patients with hypoperfusion, these fluid resuscitation volumes have similar effects on patient outcomes. This association was consistent across the three subgroups with worsened cardiac function, as well as in sensitivity analyses.

Conclusions: Our study observed that an initial fluid resuscitation volume of 10-15 mL/kg in the first 3 h was optimal for early resuscitation in septic patients with ADHF, particularly those with worsened cardiac function. These results need to be confirmed in randomized controlled trials with larger sample sizes.

急性失代偿性心力衰竭脓毒症患者的最佳液体复苏目标。
背景:确定急性失代偿性心力衰竭(ADHF)脓毒症患者最佳液体复苏量:确定急性失代偿性心力衰竭(ADHF)败血症患者的最佳液体复苏量:方法:从一家三级城市医疗中心筛选出患有急性失代偿性心力衰竭(ADHF)的败血症患者。采用广义相加模型探讨液体复苏量与终点之间的关系,并根据该模型将最初 3 小时的液体复苏量分为四组:15 至 ≤ 20 mL/kg 组和 > 20 mL/kg 组。采用Logistic和Cox回归模型探讨复苏量与主要终点(院内死亡率)以及次要终点(30天死亡率、1年死亡率、有创通气和入住ICU)之间的关系:共有598名有明确心房颤动病史的脓毒症患者参与了研究,其中405名患者(68.8%)出现了脓毒症引起的低灌注。NYHA 功能分级为 III 级和 IV 级的患者分别为 494 人(83.9%)和 22 人(3.74%)。复苏量超过20毫升/千克(OR 3.19,95% CI 1.31-8.15)或低于10毫升/千克(OR 2.33,95% CI 1.14-5.20)会显著增加脓毒症患者的院内死亡风险,而复苏量在15至20毫升/千克之间与脓毒症患者的院内死亡风险无关(OR 1.79,95% CI 0.68-4.81)。在多变量 Cox 模型中,复苏量对脓毒症患者 30 天和 1 年死亡率的影响与对院内死亡率的影响相似。复苏量超过 15 毫升/千克会显著增加气管插管的风险,而液体复苏量与脓毒症患者入住重症监护室无关。在灌注不足的脓毒症患者中,这些液体复苏量对患者预后的影响相似。这种关联在心功能恶化的三个亚组以及敏感性分析中都是一致的:我们的研究发现,对于 ADHF 败血症患者,尤其是心功能恶化的患者,前 3 小时内 10-15 毫升/千克的初始液体复苏量是早期复苏的最佳选择。这些结果需要在样本量更大的随机对照试验中得到证实。
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来源期刊
BMC Medicine
BMC Medicine 医学-医学:内科
CiteScore
13.10
自引率
1.10%
发文量
435
审稿时长
4-8 weeks
期刊介绍: BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.
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