Table 2.
Comparison of outcomes by four different initial fluid resuscitation rate (ml/kg/min)
| Variables | Fluid replacement rate; ml/kg/min | ||||
|---|---|---|---|---|---|
| ≥ 0.5, N = 256 | 0.25–0.49, N = 123 | 0.17–0.24, N = 88 | < 0.17, N = 585 | P value | |
| Time to shock reversal; days | < .001‡ | ||||
| N | 232 | 103 | 73 | 506 | |
| Median (Q1, Q3) | 1.6 (0.9, 3.3) | 1.4 (0.6, 3.2) | 2.0 (0.9, 4.6) | 2.4 (1.2, 5.1) | |
| Median survival | 1.72 (1.52, 2.01) | 1.87 (1.32, 2.62) | 2.58 (2.02, 4.40) | 2.80 (2.57, 3.26) | .004§ |
| Adjusted hazard ratioa | 1.00 (ref) | 0.96 (0.76, 1.21) | 0.84 (0.65, 1.10) | 0.78 (0.66, 0.91) ** | .01¶ |
| Lactate clearance; mg/dl | < .001‡ | ||||
| N | 207 | 97 | 62 | 400 | |
| Median (Q1, Q3) | 0.5 (− 0.1, 1.3) | 0.4 (− 0.05, 1.2) | 0.6 (− 0.04, 1.2) | 0.2 (− 0.4, 0.8) | |
| Adjusted mean estimate c | 0.00 (ref) | 0.05 (− 0.27, 0.38) | 0.13 (− 0.25, 0.52) | − 0.45 (− 0.68, − 0.23)*** | < .001¶ |
| MAP change in the first 3 h; mmHg | < .001 ‡ | ||||
| N | 254 | 120 | 79 | 508 | |
| Median (Q1, Q3) | 4.3 (− 3.0, 11.5) | 4.0 (− 4.5, 11.5) | − 0.5 (− 10.5, 7.0) | 0.5 (− 5.5, 7.0) | |
| Adjusted mean estimatec | 0.00 (ref) | − 1.14 (− 4.25, 1.96) | − 3.55 (− 7.17, 0.07) | − 2.93 (− 5.10, − 0.75)** | .04¶ |
| HR change in the first 3 h; bpm | .2‡ | ||||
| N | 255 | 120 | 82 | 545 | |
| Median (Q1, Q3) | − 2.0 (− 7.5, 2.5) | − 2.3 (− 8.0, 4.3) | − 2.5 (− 9.5, 0.5) | − 1.5 (− 7.5, 3.5) | |
| Adjusted mean estimatec | 0.00 (ref) | 0.50 (− 2.06, 3.07) | − 1.41 (− 4.37, 1.54) | 1.63 (− 0.15, 3.41) | .08¶ |
| Fluid balance at T3; ml/kg | 59 (45, 79) | 44 (35, 60) | 33 (31, 41) | 7 (1, 15) | < .001‡ |
| Adjusted mean estimatec | 0.00 (ref) | 14.61 (10.63, 18.59)*** | 28.73 (24.23, 33.22)*** | 57.08 (54.34, 59.82)*** | < .001¶ |
| MICU fluid balance; ml/kg | 76 (48, 136) | 71 (40, 125) | 66 (24, 146) | 50 (16, 110) | < .001‡ |
| Adjusted mean estimatec | 0.00 (ref) | − 10 (− 34, 14) | − 6 (− 33, 21) | 13 (− 4, 29) | .1¶ |
| Fluid infusion between T3 and MICU discharge; ml/kg | 107 (50, 264) | 124 (49, 223) | 158 (62, 381) | 168 (86, 345) | < .001‡ |
| Adjusted mean estimatec | 0.00 (ref) | − 54 (− 102, − 5)* | 37 (− 18, 91) | 59 (27, 90)*** | < .001¶ |
| Duration between first vasopressor using and T0; hours | < .001‡ | ||||
| N | 233 | 102 | 75 | 502 | |
| Median (Q1, Q3) | 2.0 (0.5, 4.7) | 2.3 (1.3, 3.9) | 3.7 (1.4, 6.7) | 7.0 (2.2, 17.7) | |
| Adjusted mean estimatec | 0.00 (ref) | − 3.8 (− 12.5, 5.0) | − 2.0 (− 11.7, 7.8) | 10.3 (4.6, 15.9)*** | < .001¶ |
| SOFA change (day 2–day 1) | < .001‡ | ||||
| N | 240 | 114 | 80 | 561 | |
| Median (Q1, Q3) | − 3 (− 5, − 1) | − 2 (− 5, − 1) | − 2 (− 3.5, − 0.5) | − 2 (− 4, 0) | |
| Adjusted mean estimatec | 0.00 (ref) | − 0.09 (− 0.71, 0.53) | 0.85 (0.15, 1.55)* | 0.94 (0.52, 1.36)*** | < .001¶ |
| Mechanical ventilation; N (%) | 134 (52%) | 68 (55%) | 55 (63%) | 383 (66%) | .002† |
| Adjusted odds ratiob | 1.00 (ref) | 1.04 (0.63, 1.75) | 1.56 (0.87, 2.83) | 1.91 (1.34, 2.73)*** | .001¶ |
| Mechanical ventilation duration; days | .002‡ | ||||
| N | 134 | 68 | 55 | 383 | |
| Median (Q1, Q3) | 3 (1, 7) | 2 (1, 6) | 5 (2, 9) | 4 (2, 8) | |
| Adjusted mean estimatec | 0.00 (ref) | − 14.95 (− 66.76, 36.87) | 43.67 (− 11.93, 99.27) | 45.07 (9.60, 80.54)* | .01¶ |
| Discharge alive from MICU | 238 (93%) | 112 (91%) | 81 (92%) | 481 (82%) | < .001† |
| Median survival; days | 2.89 (2.64, 3.19) | 3.09 (2.42, 3.86) | 4.06 (3.12, 5.99) | 4.90 (4.51, 5.67) | < .001§ |
| Adjusted hazard ratioa | 1.00 (ref) | 0.95 (0.75, 1.19) | 0.74 (0.57, 0.95)* | 0.58 (0.49, 0.68)*** | < .001¶ |
| Discharge alive from hospital | 225 (88%) | 93 (76%) | 68 (77%) | 415 (71%) | < .001† |
| Median survival; days | 10.09 (8.51, 11.80) | 12.51 (9.77, 15.03) | 16.81 (13.66, 21.01) | 17.69 (15.45, 19.96) | < .001§ |
| Adjusted hazard ratioa | 1.00 (ref) | 0.84 (0.66, 1.08) | 0.58 (0.44, 0.76)*** | 0.53 (0.45, 0.63)*** | < .001¶ |
| MICU mortality; N (%) | 18 (7%) | 11 (9%) | 7 (8%) | 104 (18%) | < .001† |
| Adjusted odds ratiob | 1.00 (ref) | 1.34 (0.59, 3.03) | 1.12 (0.44, 2.87) | 3.40 (1.95, 5.93)*** | < .001¶ |
| Hospital mortality; N (%) | 31 (12%) | 30 (24%) | 20 (23%) | 170 (29%) | < .001† |
| Adjusted odds ratiob | 1.00 (ref) | 2.53 (1.41, 4.52)** | 2.23 (1.17, 4.27)* | 3.51 (2.27, 5.44)*** | < .001¶ |
| 28-day mortality; N (%) | 41 (16%) | 32 (26%) | 21 (24%) | 199 (34%) | < .001† |
| Adjusted odds ratiob | 1.00 (ref) | 1.97 (1.12, 3.45)* | 1.86 (0.99, 3.51) | 3.19 (2.13, 4.78)*** | < .001¶ |
Numbers indicate N (%) and median (Q1, Q3) unless otherwise noted
Unadjusted models contain just fluid resuscitation rate adjusted models are additionally adjusted for the effects of age, gender, white race, weight, CCI, APACHE III, and SOFA
Compared to ≥ 0. 5 ml/kg/min group, *P value < 0.05, **P value < 0.01, ***P value < 0.001
†Chi-square
‡Kruskal-Wallis
§Log-rank test
¶Type 3 Wald test
aAnalyzed using proportional hazards regression models
bAnalyzed using logistic regression models
cAnalyzed using linear regression models