Impact of fluid creep on volume and chloride load in critically ill adults: a prospective study on its prognostic significance and association with MAKE30

To quantify ICU fluids for different uses, identify significant fluid sources for volume and chloride load in critically ill adults, and analyze their impact on prognosis. A prospective study was conducted in a 52-bed academic ICU. From May to December 2022, volume intake/output and fluid purpose were recorded for 5 days for all admitted patients. Fluids were categorized into five types. Patients were divided into high and low fluid creep groups by median dosage. Logistic regression was used to analyze the association with Major Adverse Kidney Events by 30 days (MAKE30). 1,633 adult critically ill patients with a median age of 67 years and an APACHE II score of 22 were included. Fluid creep, with a median of 802 ml, accounted for 48.4% of daily fluid volume, far more than resuscitation (8.6%) or maintenance/replacement fluid (6.7%). After adjustment for confounders, high fluid creep was associated with a higher incidence of MAKE30 (OR = 1.37) and its components, including in-hospital mortality (OR = 1.49), new renal replacement therapy (OR = 1.83), and persistent renal damage (OR = 1.75). Fluid creep is an important source of volume and chloride load in critically ill adults, and high volumes are associated with a higher incidence of MAKE30. Intravenous fluid therapy should be used with caution.