Association of day 4 cumulative fluid balance with mortality in critically ill patients with influenza

A multicenter retrospective cohort study in Taiwan

Wen Cheng Chao, Chien Hua Tseng, Ying Chun Chien, Chau Chyun Sheu, Ming Ju Tsai, Wen Feng Fang, Yu Mu Chen, Kuo Chin Kao, Han Chung Hu, Wann Cherng Perng, Kuang Yao Yang, Wei Chih Chen, Shinn Jye Liang, Chieh Liang Wu, Hao Chien Wang, Ming Cheng Chan

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

Background Fluid balance is a fundamental management of patients with sepsis, and this study aimed to investigate the impact of cumulative fluid balance on critically ill patients with influenza admitted to an intensive care unit (ICU). Methods This multicenter retrospective cohort study was conducted by the Taiwan Severe Influenza Research Consortium (TSIRC) which includes eight medical centers. Patients with virology-proven influenza infection admitted to ICUs between October 2015 and March 2016 were included for analysis. Results A total of 296 patients were enrolled (mean age: 61.4±15.6 years; 62.8% men), and 92.2% (273/296) of them required mechanical ventilation. In the survivors, the daily fluid balance was positive from day 1 to day 3, and then gradually became negative from day 4 to day 7, whereas daily fluid balance was continuously positive in the non-survivors. Using the cumulative fluid balance from day 1–4 as a cut-off point, we found that a negative cumulative day 1–4 fluid balance was associated with a lower 30-day mortality rate (log-rank test, P = 0.003). To evaluate the impact of shock on this association, we divided the patients into shock and non-shock groups. The positive correlation between negative day 1–4 fluid balance and mortality was significant in the non-shock group (log-rank test, P = 0.008), but not in the shock group (log-rank test, P = 0.396). In a multivariate Cox proportional hazard regression model adjusted for age, sex, cerebrovascular disease, and PaO2/FiO2, day 1–4 fluid balance was independently associated with a higher 30-day mortality rate (aHR 1.088, 95% CI: 1.007–1.174). Conclusions A negative day 1–4 cumulative fluid balance was associated with a lower mortality rate in critically ill patients with influenza. Our findings indicate the critical role of conservative fluid strategy in the management of patients with complicated influenza.

Original languageEnglish
Article numbere0190952
JournalPLoS One
Volume13
Issue number1
DOIs
Publication statusPublished - Jan 1 2018
Externally publishedYes

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Water-Electrolyte Balance
cohort studies
Taiwan
Critical Illness
influenza
Human Influenza
Cohort Studies
Retrospective Studies
Fluids
Mortality
Shock
Intensive care units
testing
fluids
Cerebrovascular Disorders
cerebrovascular disorders
Virology
virology
sepsis (infection)
Artificial Respiration

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Association of day 4 cumulative fluid balance with mortality in critically ill patients with influenza : A multicenter retrospective cohort study in Taiwan. / Chao, Wen Cheng; Tseng, Chien Hua; Chien, Ying Chun; Sheu, Chau Chyun; Tsai, Ming Ju; Fang, Wen Feng; Chen, Yu Mu; Kao, Kuo Chin; Hu, Han Chung; Perng, Wann Cherng; Yang, Kuang Yao; Chen, Wei Chih; Liang, Shinn Jye; Wu, Chieh Liang; Wang, Hao Chien; Chan, Ming Cheng.

In: PLoS One, Vol. 13, No. 1, e0190952, 01.01.2018.

Research output: Contribution to journalReview article

Chao, WC, Tseng, CH, Chien, YC, Sheu, CC, Tsai, MJ, Fang, WF, Chen, YM, Kao, KC, Hu, HC, Perng, WC, Yang, KY, Chen, WC, Liang, SJ, Wu, CL, Wang, HC & Chan, MC 2018, 'Association of day 4 cumulative fluid balance with mortality in critically ill patients with influenza: A multicenter retrospective cohort study in Taiwan', PLoS One, vol. 13, no. 1, e0190952. https://doi.org/10.1371/journal.pone.0190952
Chao, Wen Cheng ; Tseng, Chien Hua ; Chien, Ying Chun ; Sheu, Chau Chyun ; Tsai, Ming Ju ; Fang, Wen Feng ; Chen, Yu Mu ; Kao, Kuo Chin ; Hu, Han Chung ; Perng, Wann Cherng ; Yang, Kuang Yao ; Chen, Wei Chih ; Liang, Shinn Jye ; Wu, Chieh Liang ; Wang, Hao Chien ; Chan, Ming Cheng. / Association of day 4 cumulative fluid balance with mortality in critically ill patients with influenza : A multicenter retrospective cohort study in Taiwan. In: PLoS One. 2018 ; Vol. 13, No. 1.
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abstract = "Background Fluid balance is a fundamental management of patients with sepsis, and this study aimed to investigate the impact of cumulative fluid balance on critically ill patients with influenza admitted to an intensive care unit (ICU). Methods This multicenter retrospective cohort study was conducted by the Taiwan Severe Influenza Research Consortium (TSIRC) which includes eight medical centers. Patients with virology-proven influenza infection admitted to ICUs between October 2015 and March 2016 were included for analysis. Results A total of 296 patients were enrolled (mean age: 61.4±15.6 years; 62.8{\%} men), and 92.2{\%} (273/296) of them required mechanical ventilation. In the survivors, the daily fluid balance was positive from day 1 to day 3, and then gradually became negative from day 4 to day 7, whereas daily fluid balance was continuously positive in the non-survivors. Using the cumulative fluid balance from day 1–4 as a cut-off point, we found that a negative cumulative day 1–4 fluid balance was associated with a lower 30-day mortality rate (log-rank test, P = 0.003). To evaluate the impact of shock on this association, we divided the patients into shock and non-shock groups. The positive correlation between negative day 1–4 fluid balance and mortality was significant in the non-shock group (log-rank test, P = 0.008), but not in the shock group (log-rank test, P = 0.396). In a multivariate Cox proportional hazard regression model adjusted for age, sex, cerebrovascular disease, and PaO2/FiO2, day 1–4 fluid balance was independently associated with a higher 30-day mortality rate (aHR 1.088, 95{\%} CI: 1.007–1.174). Conclusions A negative day 1–4 cumulative fluid balance was associated with a lower mortality rate in critically ill patients with influenza. Our findings indicate the critical role of conservative fluid strategy in the management of patients with complicated influenza.",
author = "Chao, {Wen Cheng} and Tseng, {Chien Hua} and Chien, {Ying Chun} and Sheu, {Chau Chyun} and Tsai, {Ming Ju} and Fang, {Wen Feng} and Chen, {Yu Mu} and Kao, {Kuo Chin} and Hu, {Han Chung} and Perng, {Wann Cherng} and Yang, {Kuang Yao} and Chen, {Wei Chih} and Liang, {Shinn Jye} and Wu, {Chieh Liang} and Wang, {Hao Chien} and Chan, {Ming Cheng}",
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T1 - Association of day 4 cumulative fluid balance with mortality in critically ill patients with influenza

T2 - A multicenter retrospective cohort study in Taiwan

AU - Chao, Wen Cheng

AU - Tseng, Chien Hua

AU - Chien, Ying Chun

AU - Sheu, Chau Chyun

AU - Tsai, Ming Ju

AU - Fang, Wen Feng

AU - Chen, Yu Mu

AU - Kao, Kuo Chin

AU - Hu, Han Chung

AU - Perng, Wann Cherng

AU - Yang, Kuang Yao

AU - Chen, Wei Chih

AU - Liang, Shinn Jye

AU - Wu, Chieh Liang

AU - Wang, Hao Chien

AU - Chan, Ming Cheng

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background Fluid balance is a fundamental management of patients with sepsis, and this study aimed to investigate the impact of cumulative fluid balance on critically ill patients with influenza admitted to an intensive care unit (ICU). Methods This multicenter retrospective cohort study was conducted by the Taiwan Severe Influenza Research Consortium (TSIRC) which includes eight medical centers. Patients with virology-proven influenza infection admitted to ICUs between October 2015 and March 2016 were included for analysis. Results A total of 296 patients were enrolled (mean age: 61.4±15.6 years; 62.8% men), and 92.2% (273/296) of them required mechanical ventilation. In the survivors, the daily fluid balance was positive from day 1 to day 3, and then gradually became negative from day 4 to day 7, whereas daily fluid balance was continuously positive in the non-survivors. Using the cumulative fluid balance from day 1–4 as a cut-off point, we found that a negative cumulative day 1–4 fluid balance was associated with a lower 30-day mortality rate (log-rank test, P = 0.003). To evaluate the impact of shock on this association, we divided the patients into shock and non-shock groups. The positive correlation between negative day 1–4 fluid balance and mortality was significant in the non-shock group (log-rank test, P = 0.008), but not in the shock group (log-rank test, P = 0.396). In a multivariate Cox proportional hazard regression model adjusted for age, sex, cerebrovascular disease, and PaO2/FiO2, day 1–4 fluid balance was independently associated with a higher 30-day mortality rate (aHR 1.088, 95% CI: 1.007–1.174). Conclusions A negative day 1–4 cumulative fluid balance was associated with a lower mortality rate in critically ill patients with influenza. Our findings indicate the critical role of conservative fluid strategy in the management of patients with complicated influenza.

AB - Background Fluid balance is a fundamental management of patients with sepsis, and this study aimed to investigate the impact of cumulative fluid balance on critically ill patients with influenza admitted to an intensive care unit (ICU). Methods This multicenter retrospective cohort study was conducted by the Taiwan Severe Influenza Research Consortium (TSIRC) which includes eight medical centers. Patients with virology-proven influenza infection admitted to ICUs between October 2015 and March 2016 were included for analysis. Results A total of 296 patients were enrolled (mean age: 61.4±15.6 years; 62.8% men), and 92.2% (273/296) of them required mechanical ventilation. In the survivors, the daily fluid balance was positive from day 1 to day 3, and then gradually became negative from day 4 to day 7, whereas daily fluid balance was continuously positive in the non-survivors. Using the cumulative fluid balance from day 1–4 as a cut-off point, we found that a negative cumulative day 1–4 fluid balance was associated with a lower 30-day mortality rate (log-rank test, P = 0.003). To evaluate the impact of shock on this association, we divided the patients into shock and non-shock groups. The positive correlation between negative day 1–4 fluid balance and mortality was significant in the non-shock group (log-rank test, P = 0.008), but not in the shock group (log-rank test, P = 0.396). In a multivariate Cox proportional hazard regression model adjusted for age, sex, cerebrovascular disease, and PaO2/FiO2, day 1–4 fluid balance was independently associated with a higher 30-day mortality rate (aHR 1.088, 95% CI: 1.007–1.174). Conclusions A negative day 1–4 cumulative fluid balance was associated with a lower mortality rate in critically ill patients with influenza. Our findings indicate the critical role of conservative fluid strategy in the management of patients with complicated influenza.

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