The following article is a part of conference coverage from CHEST 2021, being held virtually from October 17 to October 20, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from CHEST 2021.

 

Hospital fluid culture is highly influential in determining the volume of treatment fluid administered to critically ill patients and their outcomes, according to an observational study presented at the CHEST 2021 Annual Meeting, held virtually from October 17 to 20, 2021.


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Day-1 fluid (DOF) administration can have a large impact on critical care outcomes. Researchers therefore investigated the relationship between outcomes and illness severity, patient propensity to receive fluid, and hospital practice. The investigation included 51,422 medically managed patients with severe sepsis and septic shock from 104 hospital in the Truven Hospital Drug Database from 2013 to 2016. Characteristics of patients included in the study were as follows: an infection and acute organ dysfunction present on admission; day 1 emergency room admission; treatment with antibiotics; intensive care unit admission; and a DOF volume of 1-15L.

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. Average DOF was also calculated for each hospital, with each hospital then characterized as either a low-fluid hospital (LFH) or a high-fluid hospital (HFH). Researchers also created 3 patient severity groups: low severity (no ventilation and no specific diagnosis codes); medium severity (diagnosis of severe sepsis, septic shock, or mechanical ventilation, but no day 1-2 vasopressors); and high severity (shock with same diagnoses as the medium group but with day 1-2 vasopressors). Risk adjustments were made for differences in mortality between low- and high-fluid hospitals and the data was then analyzed to explore the relationships between the various groups.

Investigators found that patient factors accounted for 17.5% of DOF variation, and hospital fluid group accounted for 12.5% of variation. Mean hospital DOF was 2.7-5.3L, 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 with HFH (22.6 vs 20.1%, P <.05). For low-severity patients, there was no difference in mortality at LFH (16.9%) compared with HFH (14.8%; P >.05). Medium severity patients had higher mortality at LFH (16.9%) compared with HFH (14.8%; P >.05). High severity LFP patients had similar mortality at both LFH (32.7%) and HFH (31.9%, P >.05). Notably, patients categorized as both high severity and HFP exhibited a 14% higher risk of mortality at LFH (41.1%) compared with HFH (36.1%; P <.05).

“Hospital fluid culture has almost 2/3 the impact of patient factors for DOF received in patients with sepsis,” investigators concluded. They added that the finding that patients with septic shock with high fluid propensity at low-fluid hospitals had much higher mortality suggested that focusing more squarely on patient factors might improve patient outcomes.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Alam A, Corl K, Douglas I, et al. Hospital fluid culture impacts outcome in severe sepsis and septic shock patients. Presented at: CHEST 2021; October 17-20, 2021; Orlando, FL/Virtual. Abstract A1063-A10644.