ArticleTherapeutic advances in cardiovascular disease
The first 24-h negative fluid balance is related to lower short-term mortality but higher AKI progression in critically ill heart failure: a retrospective cohort study.
Article in Therapeutic advances in cardiovascular disease. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCurrent guidelines lack instruction on fluid administration for patients with critically ill heart failure (HF) in the intensive care unit.
objectivesThis study aims to compare the risk of mortality and acute kidney injury (AKI) outcomes among unlimited intake, restrictive intake, and negative balance.
designRetrospective cohort study.
methodsA total of 3267 patients with HF not receiving renal replacement therapy were included from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and were grouped into restrictive fluid intake (the first 24-h fluid intake from 1500 to 2000 mL), negative fluid balance management (the first 24-h net output >1000 mL), and unlimited fluid control groups. The primary endpoint was 28-day mortality, and the secondary endpoints were morbidity of 48-h AKI, 7-day AKI, and AKI progression from 48 h to 7 days. The odds ratio (OR) and the 95% confidence interval (CI) were estimated by multivariable logistic regression, and mediation analyses were performed.
resultsNegative fluid balance, not restrictive fluid intake, was correlated to a lower risk of 28-day mortality (OR: 0.750 (0.570-0.987),
conclusionNegative fluid balance was related to lower risk of 28-day mortality, 48-h AKI, and 7-day AKI but a higher risk of AKI progression, which requires further clinical trials for validation.
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