The following article is part of the coverage of the CHEST 2021 conference, which will be held virtually October 17-20, 2021. The Pulmonology Advisor team will report on the latest news and research from leading experts in the field. Check back for more of CHEST 2021.
Hospital fluid culture is very influential in determining the volume of treatment fluid given to critically ill patients and their results, according to an observational study presented at the CHEST 2021 annual meeting, held virtually October 17-20, 2021 .
Fluid administration on day 1 (DOF) can have a significant impact on the outcome of intensive care. The researchers therefore studied the relationship between the outcome and the severity of the disease, the propensity of patients to receive fluids and hospital practice. The survey covered 51,422 medically treated patients with severe sepsis and septic shock from 104 hospitals in the Truven Hospital Drug Database from 2013 to 2016. Characteristics of patients included in the survey study were as follows: infection and acute organ dysfunction present on admission; admission to the emergency room on day 1; treatment with antibiotics; admission to intensive care unit; and a DOF volume of 1-15L.
The researchers then created a DOF fluid propensity model. Patient demographics and comorbidities were used to divide patients into 2 groups: a low fluid propensity (LFP) group and a high fluid propensity (HFP) group. The mean DOF was also calculated for each hospital, with each hospital then being characterized as a low-flow hospital (LFH) or a high-flow hospital (HFH). The researchers also created 3 patient severity groups: low severity (no ventilation and no specific diagnostic codes); moderate severity (diagnosis of severe sepsis, septic shock or mechanical ventilation, but no vasopressors on day 1-2); and high severity (shock with the same diagnoses as the average group but with vasopressors on day 1-2). Risk adjustments were made to account for differences in mortality between hospitals with low and high humidity, and the data was then analyzed to explore relationships between different groups.
Investigators found that patient-related factors accounted for 17.5% of the change in DOF and the hospital fluids group accounted for 12.5% ââof the variation. The mean DOF at the hospital was 2.7 to 5.3 L, with the proportion of high severity patients being the same at both LFH (38.5%) and HFH (38.3%).
Hospital mortality was significantly higher at LFH compared to HFH (22.6 vs 20.1%, P <.05 for patients of low severity there was no difference in mortality at lfh compared with hfh>P > .05). Patients of moderate severity had higher mortality from LFH (16.9%) compared to HFH (14.8%; P>.05). Patients with high severity LFP had similar mortality to both LFH (32.7%) and HFH (31.9%, P > .05). Notably, patients classified as both high severity and HFP had a 14% higher risk of mortality from LFH (41.1%) compared to HFH (36.1%; P <.05>
“Hospital fluid culture has almost 2/3 of the impact of patient-related factors for DOF received in patients with sepsis,” the investigators concluded. They added that the finding that patients with septic shock with a high propensity to fluids in low-fluid hospitals had much higher mortality suggested that focusing more on patient-related factors could improve patient outcomes. .
Disclosure: Some study authors reported affiliations with biotechnology, pharmaceutical, and / or device companies. Please see the original reference for a full list of author disclosures.
Alam A, Corl K, Douglas I et al. Culture of hospital fluids affects outcomes in patients with severe sepsis and septic shock. Presented at: CHEST 2021; October 17-20, 2021; Orlando, Florida / Virtual. Abstract A1063-A10644.