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Updated: May 28, 2025
Evaluation of Fluid Overload by Bioelectrical Impedance Vectorial Analysis
Published on: August 17, 2022
Fluid balance and clinical outcomes in patients with aortic dissection: a retrospective case-control study based on
Jiahao Lei1, Zhuojing Zhang2,3, Yixuan Li3,4
1Department of Vascular Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China.
Insights
Fluid management is crucial for aortic dissection (AD) patients. Higher fluid intake and positive fluid balance correlate with increased mortality, while greater fluid output is linked to lower mortality in AD care.
Area of Science:
- Critical Care Medicine
- Cardiovascular Surgery
- Clinical Research
Background:
- Aortic dissection (AD) is a critical condition demanding intensive management.
- The role of fluid management in AD patient care remains incompletely understood despite existing research.
Purpose of the Study:
- To investigate the association between fluid management strategies and in-hospital mortality in patients with aortic dissection.
- To explore the impact of fluid intake, output, and balance on clinical outcomes for AD patients.
Main Methods:
- Retrospective case-control study utilizing data from two large public ICU databases (MIMIC-IV and eICU Collaborative Research Database).
- Inclusion of 751 adult AD patients with detailed fluid management records from 2008 to 2019.
- Calculation of mean 24-hour fluid intake, output, and balance; assessment of their relationship with all-cause in-hospital mortality via regression analyses.
Main Results:
- Positive correlation found between mean 24-hour fluid intake and in-hospital mortality (OR 1.029, p<0.001).
- Negative correlation observed between mean 24-hour fluid output and in-hospital mortality (OR 0.941, p<0.001).
- Positive correlation noted for mean 24-hour fluid balance (OR 1.030, p<0.001), with a predictive cut-off of 5.12 L for mortality (AUC=0.778).
Conclusions:
- Fluid balance is a significant factor in the clinical management of aortic dissection patients.
- Findings suggest optimizing fluid management and monitoring strategies beyond traditional hemodynamic parameters.
- This study provides novel insights into improving patient outcomes through tailored fluid management in AD.
Objectives:
Aortic dissection (AD) is a life-threatening condition that requires intensive care and management. This paper explores the role of fluid management in the clinical care of AD patients, which has been unclear despite the substantial existing research that has been conducted on the treatment of AD.
Design:
A retrospective case-control study using data for AD patients from public databases.
Setting:
Two public intensive care unit (ICU) databases with hospital courses from the USA, Medical Information Mart for Intensive Care (MIMIC)-IV critical care dataset and the eICU Collaborative Research Database, with data from 2008 to 2019.
Participants:
A total of 751 adult AD patients with detailed fluid management records from two databases were included.
Interventions:
The mean 24-hour intake and output were calculated by dividing the total amount of intake and output by the number of days in the ICU, respectively. The mean 24-hour fluid balance was generated by subtracting the output from the intake.
Outcome Measures:
The relationship between the mean 24-hour fluid management and all-cause in-hospital death was assessed through univariate and multivariable regression analyses.
Results:
A positive correlation was found between mean 24-hour fluid intake and in-hospital mortality among AD patients (OR 1.029, 95% CI (1.018, 1.041), p<0.001), whereas a negative correlation was revealed between mean 24-hour fluid output and in-hospital mortality (OR 0.941, 95% CI (0.914, 0.968), p<0.001). A similar result was found for mean 24-hour fluid balance (OR 1.030, 95% CI (1.019, 1.042), p<0.001), and the cut-off was selected to be 5.12 dL (AUC=0.778, OR 3.066, 95% CI (1.634, 5.753), p<0.001).
Conclusions:
This study stresses the importance of fluid balance in the clinical care of AD patients and provides new insights for optimising fluid management and monitoring strategies beyond the conventional focus on blood pressure and heart rate management.
