Evidence map›Paper›PMID 38694845›Full record

ArticleCritical care explorations2024

Associations Between Volume of Early Intravenous Fluid and Hospital Outcomes in Septic Patients With and Without Heart Failure: A Retrospective Cohort Study.

Alexander J Beagle, Priya A Prasad, Colin C Hubbard, Sven Walderich, Sandra Oreper, Yumiko Abe-Jones, Margaret C Fang, Kirsten N Kangelaris

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care explorations, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
2.3field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.

  1. Guideline
  2. Evidence-based fluid resuscitation of the septic HFpEF patient: A narrative review of the literature.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2026
    Review
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Alexander J BeagleDepartment of Medicine, University of California, San Francisco, San Francisco, CA.
Priya A PrasadDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Colin C HubbardDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Sven WalderichDivision of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Sandra OreperDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Yumiko Abe-JonesDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Margaret C FangDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Kirsten N KangelarisDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.
San Francisco General Hospital · USUniversity of California, San Francisco · US

Funding

Use and outcomes of anticoagulants for the treatment and prevention of thrombosis among hospitalized patientsK24HL141354 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI FANG, MARGARET C. · 2018 to 2022
$731k
NHLBI NIH HHS K24 HL141354
6 · The paper itself

Abstract

objectivesTo evaluate the relationship between early IV fluid volume and hospital outcomes, including death in-hospital or discharge to hospice, in septic patients with and without heart failure (HF).

designA retrospective cohort study using logistic regression with restricted cubic splines to assess for nonlinear relationships between fluid volume and outcomes, stratified by HF status and adjusted for propensity to receive a given fluid volume in the first 6 hours. An ICU subgroup analysis was performed. Secondary outcomes of vasopressor use, mechanical ventilation, and length of stay in survivors were assessed.

settingAn urban university-based hospital. PATIENTS: A total of 9613 adult patients were admitted from the emergency department from 2012 to 2021 that met electronic health record-based Sepsis-3 criteria. Preexisting HF diagnosis was identified by the

interventionsNone. MEASUREMENTS AND MAIN

resultsThere were 1449 admissions from patients with HF. The relationship between fluid volume and death or discharge to hospice was nonlinear in patients without HF, and approximately linear in patients with HF. Receiving 0-15 mL/kg in the first 6 hours was associated with lower likelihood of death or discharge to hospice compared with 30-45 mL/kg (odds ratio = 0.61; 95% CI, 0.41-0.90;

conclusionsEarly fluid resuscitation showed distinct patterns of potential harm and benefit between patients with and without HF who met Sepsis-3 criteria. Restricted cubic splines analysis highlighted the importance of considering nonlinear fluid outcomes relationships and identified potential points of diminishing returns (15-30 mL/kg across all patients without HF and 30-45 mL/kg when admitted to the ICU). Receiving less than 15 mL/kg was associated with better outcomes in HF patients, suggesting small volumes may be appropriate in select patients. Future studies may benefit from investigating nonlinear fluid-outcome associations and a focus on other conditions like HF.

Indexed as

Fluid TherapyHeart FailureSepsisAgedCohort StudiesFemaleHospital MortalityHumansIntensive Care UnitsLength of StayMaleMiddle AgedRetrospective Studiesfluid therapyheart failureintensive care unitsregression analysissepsis

Identifiers

PMID38694845
PMCPMC11057813
OpenAlexW4395676589

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.