Impact of Early Fluid Balance on Long-Term Mortality in Critically Ill Surgical Patients: A Retrospective Cohort Study in Central Taiwan

Fluid balance is an essential issue in critical care; however, the impact of early fluid balance on the long-term mortality in critically ill surgical patients remains unknown. This study aimed to address the impact of day 1–3 and day 4–7 fluid balance on the long-term mortality in critically ill surgical patients. We enrolled patients who were admitted to surgical intensive care units (ICUs) during 2015–2019 at a tertiary hospital in central Taiwan and retrieved date-of-death from the Taiwanese nationwide death registration profile. We used a Log-rank test and a multivariable Cox proportional hazards regression model to determine the independent mortality impact of early fluid balance. A total of 6978 patients were included for analyses (mean age: 60.9 ± 15.9 years; 63.9% of them were men). In-hospital mortality, 90-day mortality, 1-year and overall mortality was 10.3%, 15.8%, 23.8% and 31.7%, respectively. In a multivariable Cox proportional hazard regression model adjusted for relevant covariates, we found that positive cumulative day 4–7 fluid balance was independently associated with long-term mortality (aHR 1.083, 95% CI 1.062–1.105), and a similar trend was found on day 1–3 fluid balance, although to a lesser extent (aHR 1.027, 95% CI 1.011–1.043). In conclusion, the fluid balance in the first week of ICU stay, particularly day 4–7 fluid balance, may affect the long-term outcome in critically ill surgical patients.

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Red cell distribution width predicts long-term mortality in critically ill surgical patients

International Journal of Surgery ◽

10.1016/j.ijsu.2015.04.029 ◽

2015 ◽

Vol 18 ◽

pp. 243-244

Author(s):

Dominic Marshall ◽

Marco Pimentel ◽

Joseph Shalhoub ◽

Justin D. Salciccioli

Keyword(s):

Critically Ill ◽

Red Cell Distribution Width ◽

Surgical Patients ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Critically Ill Surgical Patients ◽

Long Term Mortality

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The association between culture positivity and long-term mortality in critically ill surgical patients

Journal of Intensive Care ◽

10.1186/s40560-021-00576-2 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Yu-Cheng Wu ◽

Li-Ting Wong ◽

Chieh-Liang Wu ◽

Wen-Cheng Chao

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Positive Culture ◽

Surgical Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Culture Positivity ◽

Critically Ill Surgical Patients ◽

Long Term Mortality

Abstract Background The long-term outcome is an essential issue in critically ill patients, and the identification of early determinant is needed for risk stratification of the long-term outcome. In the present study, we investigate the association between culture positivity during admission and long-term outcome in critically ill surgical patients. Methods We linked the 2015–2019 critical care database at Taichung Veterans General Hospital with the nationwide death registration files in Taiwan. We described the long-term mortality and proportion of culture positivity among enrolled subjects. We used a log-rank test to estimate survival curves between patients with and without positive cultures and a multivariable Cox proportional hazards regression model to determine hazard ratio (HR) and 95% confidence interval (CI). Results A total of 6748 critically ill patients were enrolled, and 32.5% (2196/6749) of them died during the follow-up period, with the overall follow-up duration was 1.8 ± 1.4 years. We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively. We found that a positive culture from any sites was independently associated with high long-term mortality (aHR 1.579, 95% CI 1.422–1.754) after adjusting relevant covariates, including age, sex, body-mass index, comorbidities, severity score, shock, early fluid overload, receiving mechanical ventilation and the need of renal replacement therapy for critical illness. Conclusions We linked two databases to identify that a positive culture during admission was independently correlated with increased long-term mortality in critically ill surgical patients. Our findings highlight the need for vigilance among patients with a positive culture during admission, and more studies are warranted to validate our findings and to clarify underlying mechanisms.

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The Impact of IV Electrolyte Replacement on the Fluid Balance of Critically Ill Surgical Patients

The American Surgeon ◽

10.1177/000313481908501021 ◽

2019 ◽

Vol 85 (10) ◽

pp. 1171-1174 ◽

Cited By ~ 1

Author(s):

Andrew S. Wang ◽

Navpreet K. Dhillon ◽

Nikhil T. Linaval ◽

Nicholas Rottler ◽

Audrey R. Yang ◽

...

Keyword(s):

Critically Ill ◽

Fluid Balance ◽

Fluid Administration ◽

Surgical Patients ◽

Icu Patients ◽

Surgical Icu ◽

The Impact ◽

To Receive ◽

Electrolyte Replacement ◽

Critically Ill Surgical Patients

Avoiding excess fluid administration is necessary when managing critically ill surgical patients. The aim of this study was to delineate the current practices of IVelectrolyte (IVE) replacement in a surgical ICU and quantify their contribution to the fluid balance (FB) status. Patients admitted to the surgical ICU over a six-month period were reviewed. Patients undergoing dialysis and those with ICU stay <72 hours were excluded. A total of 248 patients were included. The median age was 60 years, and 57 per cent were male. Overall, 1131 patient ICU days were analyzed. The median daily FB was 672 mL. IVEs were administered in 62 per cent of ICU days. In days that IVEs were used, negative FB was significantly less likely to be achieved (62% vs 69%, P = 0.02). The most commonly administered IVE was calcium (32% of ICU days); however, the largest volume of IVE was administered in the form of phosphorus (median 225 mL). Diuretics were administered in 17 per cent of ICU days. Patients who received diuretics were significantly more likely to receive IVE (70% vs 61%, P = 0.02). Administration of IVE may contribute to the daily positive FB of surgical ICU patients. Implementation of practices that can ameliorate this effect is encouraged.

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