Comorbidities, Weight-Based Initial Fluid Resuscitation, and Mortality in Patients With Sepsis

Area of Science:

• Critical Care Medicine
• Sepsis Management
• Fluid Resuscitation

Background:

• Current guidelines recommend at least 30 mL/kg of initial fluid for sepsis-induced hypoperfusion.
• Uncertainty exists regarding the benefits of this fluid volume in patients with cardiac/kidney comorbidities or intermediate lactate levels.

Purpose of the Study:

• To evaluate the association between administering ≥30 mL/kg of fluid within 6 hours of hospital arrival and 30-day mortality.
• To assess this association across different patient populations with community-onset sepsis.

Main Methods:

• Cohort study including adults with community-onset sepsis requiring fluid resuscitation.
• Compared outcomes for patients receiving ≥30 mL/kg vs. <30 mL/kg of fluid within the first 6 hours.
• Used weighted regression models adjusted for patient characteristics.

Main Results:

• Fluid administration of ≥30 mL/kg was associated with lower 30-day mortality in patients with hypoperfusion or intermediate lactate elevation *without* severe comorbidities.
• No statistically significant association was found for patients with hypoperfusion *and* severe cardiac/kidney comorbidities, though trends suggested benefit.

Conclusions:

• Initial fluid resuscitation of ≥30 mL/kg is associated with reduced mortality in sepsis patients without severe cardiac or kidney comorbidities.
• Findings suggest potential benefit in broader application of this fluid volume, even in high-risk groups, warranting further investigation.