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Revisiting Post-ICU Admission Fluid Balance Across Pediatric Sepsis Mortality Risk Strata: A Secondary Analysis of a Prospective Observational Cohort Study.
Atreya, Mihir R; Cvijanovich, Natalie Z; Fitzgerald, Julie C; Weiss, Scott L; Bigham, Michael T; Jain, Parag N; Abulebda, Kamal; Lutfi, Riad; Nowak, Jeffrey; Thomas, Neal J; Baines, Torrey; Quasney, Michael; Haileselassie, Bereketeab; Sahay, Rashmi; Zhang, Bin; Alder, Matthew N; Stanski, Natalja L; Goldstein, Stuart L.
Afiliación
  • Atreya MR; Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, OH.
  • Cvijanovich NZ; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
  • Fitzgerald JC; Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, CA.
  • Weiss SL; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Bigham MT; Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE.
  • Jain PN; Department of Pediatrics, Akron Children's Hospital, Akron, OH.
  • Abulebda K; Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
  • Lutfi R; Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN.
  • Nowak J; Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN.
  • Thomas NJ; Department of Pediatrics, Children's Hospital and Clinics of Minnesota, Minneapolis, MN.
  • Baines T; Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA.
  • Quasney M; Department of Pediatrics, University of Florida Health Shands Children's Hospital, Gainesville, FL.
  • Haileselassie B; Department of Pediatrics, CS Mott Children's Hospital at the University of Michigan, Ann Arbor, MI.
  • Sahay R; Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, CA.
  • Zhang B; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, OH.
  • Alder MN; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, OH.
  • Stanski NL; Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, OH.
  • Goldstein SL; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Crit Care Explor ; 6(1): e1027, 2024 Jan.
Article en En | MEDLINE | ID: mdl-38234587
ABSTRACT

OBJECTIVES:

Post-ICU admission cumulative positive fluid balance (PFB) is associated with increased mortality among critically ill patients. We sought to test whether this risk varied across biomarker-based risk strata upon adjusting for illness severity, presence of severe acute kidney injury (acute kidney injury), and use of continuous renal replacement therapy (CRRT) in pediatric septic shock.

DESIGN:

Ongoing multicenter prospective observational cohort.

SETTING:

Thirteen PICUs in the United States (2003-2023). PATIENTS Six hundred and eighty-one children with septic shock.

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

Cumulative percent PFB between days 1 and 7 (days 1-7 %PFB) was determined. Primary outcome of interest was complicated course defined as death or persistence of greater than or equal to two organ dysfunctions by day 7. Pediatric Sepsis Biomarker Risk Model (PERSEVERE)-II biomarkers were used to assign mortality probability and categorize patients into high mortality (n = 91), intermediate mortality (n = 134), and low mortality (n = 456) risk strata. Cox proportional hazard regression models with adjustment for PERSEVERE-II mortality probability, presence of sepsis-associated acute kidney injury on day 3, and use of CRRT, demonstrated that time-dependent variable days 1-7%PFB was independently associated with an increased hazard of complicated course. Risk-stratified analyses revealed that each 10% increase in days 1-7 %PFB was associated with increased hazard of complicated course only among patients with high mortality risk strata (adjusted hazard ratio 1.24 (95% CI, 1.08-1.43), p = 0.003). However, this association was not causally mediated by PERSEVERE-II biomarkers.

CONCLUSIONS:

Our data demonstrate the influence of cumulative %PFB on the risk of complicated course in pediatric septic shock. Contrary to our previous report, this risk was largely driven by patients categorized as having a high mortality risk based on PERSEVERE-II biomarkers. Incorporation of such prognostic enrichment tools in randomized trials of restrictive fluid management or early initiation of de-escalation strategies may inform targeted application of such interventions among at-risk patients.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Crit Care Explor Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Crit Care Explor Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos