학술논문
Fluid Balance and Its Association With Mortality and Health-Related Quality of Life: A Nonprespecified Secondary Analysis of the Life After Pediatric Sepsis Evaluation
Document Type
Academic Journal
Author
Stenson, Erin K.; Banks, Russell K.; Reeder, Ron W.; Maddux, Aline B.; Zimmerman, Jerry; Meert, Kathleen L.; Mourani, Peter M.; Heidemann, Sabrina; Pawluszka, Ann; Lulic, Melanie; Berg, Robert A.; Zuppa, Athena; Twelves, Carolann; DiLiberto, Mary Ann; Pollack, Murray; Wessel, David; Berger, John; Tomanio, Elyse; Hession, Diane; Wolfe, Ashley; Carpenter, Todd; Ladell, Diane; Sierra, Yamila; Rutebemberwa, Alle; Hall, Mark; Yates, Andy; Steele, Lisa; Flowers, Maggie; Hensley, Josey; Sapru, Anil; Harrison, Rick; Ashtari, Neda; Ratiu, Anna; Carcillo, Joe; Bell, Michael; Koch, Leighann; Abraham, Alan; McQuillen, Patrick; McKenzie, Anne; Zetino, Yensy; Newth, Christopher; Kwok, Jeni; Yamakawa, Amy; Quasney, Michael; Shanley, Thomas; Jayachandran, CJ; Chima, Ranjit; Wong, Hector; Krallman, Kelli; Stoneman, Erin; Benken, Laura; Yunger, Toni; Chen, Catherine; Sullivan, Erin; Merritt, Courtney; Rich, Deana; McGalliard, Julie; Haaland, Wren; Whitlock, Kathryn; Salud, Derek; Dean, J Michael; Holubkov, Richard; Coleman, Whit; Sorenson, Samuel; Webster, Angie; Burr, Jeri; Bisping, Stephanie; Liu, Teresa; Stock, Emily; Flick, Kristi; Varni, James
Source
Pediatric Critical Care Medicine. Oct 01, 2023 24(10):829-839
Subject
Language
English
ISSN
1529-7535
Abstract
OBJECTIVES:: To evaluate the association between fluid balance (FB) and health-related quality of life (HRQL) among children at 1 month following community-acquired septic shock. DESIGN:: Nonprespecified secondary analysis of the Life After Pediatric Sepsis Evaluation. FB was defined as 100 × [(cumulative PICU fluid input – cumulative PICU fluid output)/PICU admission weight]. Three subgroups were identified: low FB (< 5%), medium FB (5%–15%), and high FB (> 15%) based on cumulative FB on days 0–3 of ICU stay. HRQL was measured at ICU admission and 1 month after using Pediatric Quality of Life Inventory 4.0 Generic Core or Infant Scales or the Stein-Jessop Functional Status Scale. The primary outcome was a composite of mortality or greater than 25% decline in HRQL 1 month after admission compared with baseline. SETTING:: Twelve academic PICUs in the United States. PATIENTS:: Critically ill children between 1 month and 18 years, with community-acquired septic shock who survived to at least day 4. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Two hundred ninety-three patients were included of whom 66 (23%) had low FB, 127 (43%) had medium FB, and 100 (34%) had high FB. There was no difference in Pediatric Risk of Mortality Score 3 (median 11 [6, 17]), age (median 5 [1, 12]), or gender (47% female) between FB groups. After adjusting for potential confounders and comparing with medium FB, higher odds of mortality or greater than 25% HRQL decline were seen in both the low FB (odds ratio [OR] 2.79 [1.20, 6.57]) and the high FB (OR 2.16 [1.06, 4.47]), p = 0.027. Compared with medium FB, low FB (OR 4.3 [1.62, 11.84]) and high FB (OR 3.29 [1.42, 8.00]) had higher odds of greater than 25% HRQL decline. CONCLUSIONS:: Over half of the children who survived septic shock had low or high FB, which was associated with a significant decline in HRQL scores. Prospective studies are needed to determine if optimization of FB can improve HRQL outcomes.