Impact of congestive heart failure on early fluid administration and mortality in patients with sepsis.

Background: Congestive heart failure (CHF) may increase the risk of volume overload and mortality in patients with sepsis, potentially complicating fluid resuscitation-a cornerstone of sepsis management. We aimed to assess whether pre-existing CHF is associated with excess mortality and different fluid administration patterns in intensive care unit patients with sepsis.

Methods: We conducted a retrospective cohort study using the MIMIC-IV database of critically ill adults with sepsis. Multivariable logistic regression and propensity score matching were used to compare in-hospital mortality and fluid resuscitation between patients with and without CHF. Generalized additive models assessed the relationship between fluid volume and mortality.

Results: Among 24,376 patients with sepsis, 6838 (28.1 %) had CHF. CHF was associated with higher in-hospital mortality (14.3 % vs. 9.8 %, p < 0.001) and lower 24-hour fluid volume (median 1936 mL vs. 3037 mL, p < 0.001). Adjusted odds of mortality were higher in CHF patients (OR 1.25, 95 % CI 1.14-1.37; p < 0.001). A U-shaped association between fluid volume and mortality was observed in non-CHF patients, with the lowest mortality at ~60 mL/kg. In CHF patients, high fluid administration did not improve survival, while restrictive strategies increased mortality.

Conclusions: Pre-existing CHF is linked to higher mortality in sepsis. Adequate fluid administration improved mortality in those without CHF, while in CHF patients, neither liberal nor restrictive fluid administration showed a clear mortality benefit.