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Relation between fluid overload and mortality in children with septic shock

Horacio Márquez-González1,2, Luis Casanova-Bracamontes3, C Mireya Muñoz-Ramírez4,3

  • 1Hospitalización, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México. horacioinvestigacion@ hotmail.com.

Archivos Argentinos De Pediatria
|March 15, 2019
PubMed

Insights

Fluid overload greater than 10.1% in children with septic shock is linked to increased mortality. This finding highlights the importance of monitoring fluid balance in pediatric septic shock patients.

Area of Science:

  • Pediatric Critical Care Medicine
  • Resuscitation Science
  • Pediatric Infectious Diseases

Background:

  • Septic shock is a leading cause of death in children.
  • Fluid resuscitation is the primary treatment for septic shock.
  • Understanding factors influencing mortality is crucial for improving outcomes.

Purpose of the Study:

  • To investigate the association between the percentage of fluid overload (%FO) and mortality in pediatric patients with septic shock.
  • To identify specific %FO thresholds that correlate with increased mortality risk.

Main Methods:

  • A cohort study was conducted on 263 children (aged 1-17 years) diagnosed with septic shock.
  • Data on %FO, central venous pressure, and other clinical parameters were collected up to 96 hours post-resuscitation.
  • Mortality and various outcome measures were tracked for 28 days using Cox proportional hazard models.

Main Results:

  • Overall mortality in the study population was 33%.
  • A %FO of 10.1% or higher at 96 hours was significantly associated with increased mortality.
  • Adjusted hazard ratios indicated that %FO >= 10.1% (HR=2.6), refractory shock (HR=2.5), and malnutrition (HR=8.3) were linked to higher mortality.

Conclusions:

  • Fluid overload exceeding 10.1% at 96 hours is a significant predictor of 28-day mortality in pediatric septic shock.
  • This association persists even after adjusting for hemodynamic status, refractory shock, and nutritional status.
  • Careful fluid management and monitoring are essential in pediatric septic shock to mitigate mortality risk.
Abstract

Keywords:
Childhood mortalityElectrolyte balanceSeptic shock

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