The Effect of Body Mass Index and Weight-Adjusted Fluid Dosing on Mortality in Sepsis.

Autor:	Ward MA; BerbeeWalsh Department of Emergency Medicine, 5232University of Wisconsin-Madison, Madison, WI, USA., Kuttab HI; BerbeeWalsh Department of Emergency Medicine, 5232University of Wisconsin-Madison, Madison, WI, USA., Lykins V JD; Department of Emergency Medicine and Internal Medicine, 6887Virginia Commonwealth University Health System, Richmond, VA, USA., Wroblewski K; Department of Public Health Sciences, 21727University of Chicago, Chicago, IL, USA., Hughes MD; BerbeeWalsh Department of Emergency Medicine, 5232University of Wisconsin-Madison, Madison, WI, USA., Keast EP; Division of Emergency Medicine, 3271NorthShore University HealthSystem, Evanston, IL, USA., Kopec JA; Division of Emergency Medicine, 8100Carle Foundation Hospital, Urbana, IL, USA., Rourke EM; Section of Emergency Medicine, 21727University of Chicago, Chicago, IL, USA., Purakal J; Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA.
Jazyk:	angličtina
Zdroj:	Journal of intensive care medicine [J Intensive Care Med] 2022 Jan; Vol. 37 (1), pp. 83-91. Date of Electronic Publication: 2020 Nov 20.
DOI:	10.1177/0885066620973917
Abstrakt:	Purpose: The Surviving Sepsis Campaign guidelines recommend 30 mL/kg of fluids within 3 hours (30by3) of sepsis-induced hypoperfusion, but a national mandate released an allowance for dosing based on ideal instead of actual body weight (IBW/ABW) for obese patients. This study aims to determine the dose-effect of 30by3 for patients with severe sepsis or septic shock (SS/SS) with respect to body mass index (BMI) categories and secondarily, examine the clinical impact of IBW vs. ABW-based dosing. Methods: Retrospective cohort study of adults (≥18 years; n = 1,032) with SS/SS presenting to an urban, tertiary-care emergency department. Models include MEDS score, antibiotic timing, lactate, renal and heart failure, among others. Results: The cohort was 10.2% underweight and 28.7% obese. Overall mortality was 17.1% with 20.4% shock mortality. An exponential increase in mortality was observed for each 5 mL/kg under 30by3 for underweight ( p = 0.02), but not obese patients. ABW vs IBW-30by3 dosing was reached in 80.0 vs 52.4% (underweight), 56.4 vs 56.9% (normal/overweight), and 23.3 vs 46.0% (obese). Across all BMI categories, there was increased mortality for not reaching ABW-based 30by3 dosing (OR 1.78, 95% CI 1.18-2.69) with no significant impact for IBW (OR 1.28, 95% CI 0.87 -1.91). The increased mortality for failing to reach ABW-dosed 30by3 remained for underweight patients ABW (OR 5.82, 95% CI 1.32-25.57) but not obese patients. Longer ICU stays were observed for not reaching 30by3 based on ABW (β = 2.40, 95% CI 0.84-3.95) and IBW dosing (β = 1.58, 95% CI 0.07-3.08) overall. This effect remained for obese and underweight (except IBW dosing) patients. Conclusions: An exponential, dose-effect increase in mortality was observed for underweight patients not receiving 30by3. Therefore, the mortality impact of under-dosing may be amplified using ABW for underweight patients. Fluid dosing did not impact mortality for obese patients, but we caution against deviation from guidelines without further studies.
Databáze:	MEDLINE
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