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Original article
Available online 16 September 2024
Relationship between fluid overload and mortality and morbidity in pediatric intensive care unit
Relación entre sobrecarga de fluidos y morbimortalidad en una unidad de cuidados intensivos pediátricos
Hilmi Bayirlia, Nazan Ulgen Tekerekb,
Corresponding author
nazanulgen@hotmail.com

Corresponding author.
, Alper Kokerb, Oguz Dursunb
a Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
b Department of Pediatric Intensive Care, Akdeniz University, Faculty of Medicine, Antalya, Turkey
Received 02 April 2024. Accepted 30 June 2024
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Tables (6)
Table 1. Demographic datas of the study population.
Table 2. Comparison of fluid accumulation.
Table 3. Comparison of demographic characteristics, morbidity and mortality by % fluid overload group.
Table 4. Multivariate log regression analysis for peak and early fluid accumulation as continuous variable.
Table 5. Multivariate log regression analysis for cumulative and early fluid accumulation as continuous variable.
Table 6. Predictive performance of fluid overload for PICU mortality.
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Additional material (1)
Abstract
Objective

The relationship between fluid overload and clinical outcomes was investigated.

Design

This study is an observational and analytic study of a retrospective cohort.

Settings

Pediatric intensive care units.

Patients or participants

Between 2019 and 2021 children who needed intensive care were included in the study.

Interventions

No intervention.

Main variable of interest

Early, peak and cumulative fluid overload were evaluated.

Results

The mortality rate was 11.7% (68/513). When fluid overloads were examined in terms of mortality, the percentage of early fluid overload was 1.86 and 3.35, the percent of peak fluid overload was 2.87 and 5.54, and the percent of cumulative fluid overload was 3.40 and 8.16, respectively, in the survivor and the non-survivor groups. After adjustment for age, severity of illness, and other potential confounders, peak (aOR = 1.15; 95%CI 1.05−1.26; p: 0.002) and cumulative (aOR = 1.10; 95%CI 1.04−1.16; p < 0.001) fluid overloads were determined as independent risk factors associated with mortality. When the cumulative fluid overload is 10% or more, a 3.9-fold increase mortality rate was calculated. It is found that the peak and cumulative fluid overload, had significant negative correlation with intensive care unit free days and ventilator free days.

Conclusions

It is found that peak and cumulative fluid overload in critically ill children were independently associated with intensive care unit mortality and morbidity.

Keywords:
Fluid overload
Mortality
Outcome
Pediatric
Resumen
Objetivo

Relación entre la sobrecarga de fluidos y el resultado clínico en niños ingresado en una UCI pediátrica.

Diseño

Estudio observacional y analítico de una cohorte retrospectiva.

Ámbito

Unidad de cuidados intensivos pediátricos (PICU)

Pacientes

Entre 2019 y 2021, se incluyeron en el estudio 581 pacientes ingresados en PICU

Intervenciones

Ninguna.

Variables de interés principals

Se evaluaron la sobrecarga de fluidos precoz, pico y acumulada.

Resultados

La tasa de mortalidad fue del 11,7% (68/513). Cuando se examinó la sobrecarga de fluidos (litros) en relación con la mortalidad, la sobrecarga precoz fue de 1,86 y 3,35, máxima de 2,87 y 5,54, y acumulada fue de 3,40 y 8,16, en supervivientes y no-supervivientes, respectivamente. Después del ajuste por edad, gravedad de la enfermedad y otros factores de confusión, se calculó el líquido máximo (aOR = 1,15; IC95% 1,05−1,26; p:0,002) y acumulado (aOR = 1,10; IC 95% 1,04−1,16; p < 0,001) como factores de riesgo independientes asociados con la mortalidad. La sobrecarga acumulada de fluidos ≥10%, se asoció con un incremento de 3,9 de la mortalidad. Las sobrecargas de fluidos máxima y acumulada tuvieron una correlación negativa significativa con días libres de permanencia en PICU, días libres de ventilación mecánica.

Conclusiones

En este estudio retrospectivo, las sobrecargas máxima y acumulativa de líquidos en niños críticamente enfermos se asoció de forma independiente con la mortalidad y morbilidad de la unidad de cuidados intensivos.

Palabras clave:
Sobrecarga de líquidos
Mortalidad
Resultado
Pediátrico

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