Assessment of outcomes in patients with heart failure and end-stage kidney disease following fluid resuscitation for sepsis and septic shock

Background Sepsis fluid resuscitation is controversial, especially for patients with volume overload risk. The Surviving Sepsis Campaign recommends a 30 mL/kg crystalloid fluid bolus for patients with sepsis-induced hypoperfusion. Criticism of this approach includes excessive fluid resuscitation in certain patients. Objective To assess the efficacy and safety of guideline-concordant fluid resuscitation in patients with sepsis and heart failure (HF) or end-stage kidney disease (ESKD). Methods A retrospective cohort study was conducted in patients with sepsis who qualified for guideline-directed fluid resuscitation and concomitant HF or ESKD. Those receiving crystalloid fluid boluses of at least 30 mL/kg within 3 hours of sepsis diagnosis were placed in the concordant group and all others in the non-concordant group. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS); vasoactive medications and net volume over 24 hours; new mechanical ventilation, new or increased volume removal, and acute kidney injury within 48 hours; and shock-free survival at 7 days. Results One hundred twenty-five patients were included in each group. In-hospital mortality was 34.4% in the concordant group and 44.8% in the non-concordant group (p-value=0.1205). The concordant group had a shorter ICU LOS (7.6 versus 10.5 days, p-value=0.0214) and hospital LOS (12.9 versus 18.3 days, p-value=0.0163) but increased new mechanical ventilation (37.6 versus 20.8%, p-value=0.0052). No differences in other outcomes were observed. Conclusion Receipt of a 30 mL/kg fluid bolus did not affect outcomes in a cohort of patients with mixed types of HF and sepsis-induced hypoperfusion.