Data_Sheet_1_Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study.docx

Sepsis management includes intravenous fluid (IVF) resuscitation, but patients with pre-existing congestive heart failure (CHF) have a higher risk of fluid overload. Further, patients with sepsis with concomitant CHF present worse clinical outcomes. Nevertheless, there is limited evidence of the association between fluid management and the outcomes of patients with concomitant sepsis and CHF. This retrospective cohort study aimed to evaluate the association between fluid management and in-hospital mortality in patients with sepsis and concomitant heart failure (HF). The patients' data were extracted from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. The primary outcome was in-hospital mortality. A restricted cubic spline model was used to explore the relationship between variables and in-hospital mortality. Logistic models were built using the linear spline function and design variables to investigate the association of fluid balance (FB), fluid intake (FI), and fluid accumulation index (FAI, calculated as the FB/FI ratio) with mortality. Overall, 1,801 patients were included. The overall mortality rate was 27.7%. After adjusting for confounding variables, FAI was found to be associated with in-hospital mortality, whereas FB and FI were not. With FAI values of 0–0.42 set as references, FAI values <0 were not associated with in-hospital mortality [odds ratio (OR): 1.078; 95% confidence interval (CI): 0.774–1.503], whereas FAI values > 0.42 were significantly associated with higher in-hospital mortality (OR: 1.461; 95% CI: 1.099–1.954). High FAI values (>0.42) were associated with high in-hospital mortality in patients with sepsis with HF, while FB and FI were not. Proper fluid management may improve the outcomes of patients with sepsis and concomitant HF.

脓毒症的管理包括静脉补液（intravenous fluid，IVF）复苏，但既往合并充血性心力衰竭（congestive heart failure，CHF）的患者发生液体超负荷的风险更高。此外，合并充血性心力衰竭的脓毒症患者临床结局更差。然而，目前关于液体管理与合并充血性心力衰竭脓毒症患者预后之间关联的证据仍较为有限。本回顾性队列研究旨在探讨液体管理与合并心力衰竭（heart failure，HF）的脓毒症患者住院死亡率之间的关联。研究数据提取自重症监护多参数智能监测III数据库（Multi-parameter Intelligent Monitoring in Intensive Care III Database）。本研究的主要结局为住院死亡率。采用限制性立方样条模型探索变量与住院死亡率之间的关系。通过线性样条函数与设计变量构建logistic回归模型，以分析液体平衡（FB）、液体摄入量（FI）及液体蓄积指数（FAI，计算方式为FB/FI比值）与死亡率的关联。本研究共纳入1801例患者，总体死亡率为27.7%。在校正混杂变量后，结果显示FAI与住院死亡率存在关联，而FB与FI则无此关联。以FAI值0~0.42作为参照组，FAI值<0的患者与住院死亡率无显著关联[比值比（OR）=1.078；95%置信区间（CI）：0.774~1.503]，而FAI值>0.42的患者住院死亡率显著升高（OR=1.461；95%CI：1.099~1.954）。合并心力衰竭的脓毒症患者中，高FAI值（>0.42）与高住院死亡率相关，而FB与FI则无此关联。合理的液体管理或可改善合并心力衰竭的脓毒症患者的临床结局。