Impact of congestive heart failure on early fluid administration and mortality in patients with sepsis

Congestive heart failure (CHF) may increase the risk of volume overload and mortality in patients with sepsis, potentially complicating fluid resuscitation-a cornerstone of sepsis management. We aimed to assess whether pre-existing CHF is associated with excess mortality and different fluid administration patterns in intensive care unit patients with sepsis.

We conducted a retrospective cohort study using the MIMIC-IV database of critically ill adults with sepsis. Multivariable logistic regression and propensity score matching were used to compare in-hospital mortality and fluid resuscitation between patients with and without CHF. Generalized additive models assessed the relationship between fluid volume and mortality.

Among 24,376 patients with sepsis, 6838 (28.1 %) had CHF. CHF was associated with higher in-hospital mortality (14.3 % vs. 9.8 %, p < 0.001) and lower 24-hour fluid volume (median 1936 mL vs. 3037 mL, p < 0.001). Adjusted odds of mortality were higher in CHF patients (OR 1.25, 95 % CI 1.14-1.37; p < 0.001). A U-shaped association between fluid volume and mortality was observed in non-CHF patients, with the lowest mortality at ~60 mL/kg. In CHF patients, high fluid administration did not improve survival, while restrictive strategies increased mortality.

Pre-existing CHF is linked to higher mortality in sepsis. Adequate fluid administration improved mortality in those without CHF, while in CHF patients, neither liberal nor restrictive fluid administration showed a clear mortality benefit.