Background: The aim of this work is to analyze the effect of a positive cumulative fluid balance and relative clinical indicators on the prognosis of patients with sepsis in the Xining area, China.
Methods: The clinical data of 480 sepsis patients (313 males and 167 females, aged 52–77 (65) years) admitted between January 2017 and December 2019 were retrospectively analyzed. The APACHE II score, SOFA score, SIRS score and clinical laboratory test indicators of the patients were collected. Receiver operating characteristic (ROC) curves were used to analyze the sensitivity and specificity of each indicator in predicting the poor prognosis of patients with sepsis, and the maximum Youden index was used to determine threshold values. Cox regression analysis was performed to assess patient prognosis using data from patients with different fluid balances.
Results: The following clinical indicators were significantly different between the 2 groups (P<0.05): APACHE II score, SOFA score, SIRS score, PCT, IL-6, BNP, CRP, PLT, BUN, CREA, Lac and total fluid balance from days 1 to 5. The area under the ROC curve (AUC) for total fluid balance from days 1 to 5 was 0.558, the cut-off value was 2120.5 mL, the sensitivity was 54.0%, and the specificity was 58.1%. The survival rates were different between the 2 groups (60.9% vs 48.9%, P<0.05). Total fluid balance was significantly higher in patients with septic shock and with Lac>2.0 mmol/L (P<0.05). Cox regression analysis indicated that APACHE II score, SOFA score, PLT score, Lac, and total fluid balance from days 1 to 5 were independent risk factors for poor prognosis.
Conclusion: A positive fluid balance from days 1 to 5 after ICU admission was associated with poor patient outcomes and was an independent risk factor for poor patient prognosis.