The Effect of Body Mass Index and Weight-Adjusted Fluid Dosing on Mortality in Sepsis.

Journal of Intensive Care Medicine
Michael A WardJohn Purakal

Abstract

The Surviving Sepsis Campaign guidelines recommend 30 mL/kg of fluids within 3 hours (30by3) of sepsis-induced hypoperfusion, but a national mandate released an allowance for dosing based on ideal instead of actual body weight (IBW/ABW) for obese patients. This study aims to determine the dose-effect of 30by3 for patients with severe sepsis or septic shock (SS/SS) with respect to body mass index (BMI) categories and secondarily, examine the clinical impact of IBW vs. ABW-based dosing. Retrospective cohort study of adults (≥18 years; n = 1,032) with SS/SS presenting to an urban, tertiary-care emergency department. Models include MEDS score, antibiotic timing, lactate, renal and heart failure, among others. The cohort was 10.2% underweight and 28.7% obese. Overall mortality was 17.1% with 20.4% shock mortality. An exponential increase in mortality was observed for each 5 mL/kg under 30by3 for underweight (p = 0.02), but not obese patients. ABW vs IBW-30by3 dosing was reached in 80.0 vs 52.4% (underweight), 56.4 vs 56.9% (normal/overweight), and 23.3 vs 46.0% (obese). Across all BMI categories, there was increased mortality for not reaching ABW-based 30by3 dosing (OR 1.78, 95% CI 1.18-2.69) with no significant impact for IBW (OR 1...Continue Reading

References

Jan 17, 2002·The New England Journal of Medicine·E RiversUNKNOWN Early Goal-Directed Therapy Collaborative Group
Apr 12, 2003·Critical Care Medicine·Mitchell M LevyUNKNOWN SCCM/ESICM/ACCP/ATS/SIS
Apr 26, 2006·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Magali PoulainFrançois Maltais
Apr 19, 2013·Critical Care : the Official Journal of the Critical Care Forum·Yaseen M ArabiUNKNOWN Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
Jun 22, 2013·Critical Care : the Official Journal of the Critical Care Forum·Petch WacharasintKeith R Walley
Mar 19, 2014·The New England Journal of Medicine·Donald M YealyDerek C Angus
Oct 2, 2014·The New England Journal of Medicine·Sandra L PeakePatricia Williams
Mar 18, 2015·The New England Journal of Medicine·Paul R MounceyUNKNOWN ProMISe Trial Investigators
Dec 24, 2015·American Journal of Respiratory and Critical Care Medicine·Vincent X LiuAlan Whippy
Jan 20, 2017·Intensive Care Medicine·Andrew RhodesR Phillip Dellinger
Apr 7, 2017·Statistics in Medicine·Per K AndersenErik T Parner
May 23, 2017·The New England Journal of Medicine·Christopher W SeymourMitchell M Levy

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Citations

Sep 17, 2021·Wiener klinische Wochenschrift·Thomas DanningerVenet Osmani

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