SynthesisBMC anesthesiology2025
Fluid balance and mortality in adult ICU patients with sepsis or septic shock: a systematic review and meta-analysis of observational studies.
Synthesis in BMC anesthesiology, 2025. 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.
What it found
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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.
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.
Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Targeting capillary leak in experimental sepsis and endotoxemia: a systematic review of therapeutic agents, methods and models in animal studies.Critical care (London, England) · 2026Pooled it
- Prognostic Impact of Cumulative Fluid Balance in Critically Ill Patients: A Retrospective Cohort Study.Cureus · 2026Article
- Diuretic therapy for critically ill patients: a systematic review and network meta-analysis.Annals of intensive care · 2026Article
- Personalised fluid therapy in septic shock.Annals of intensive care · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFluid therapy is a cornerstone of sepsis management; however, excessive fluid accumulation might be associated with adverse outcomes. The association between fluid balance (FB) and mortality in critically ill patients with sepsis or septic shock remains uncertain.
methodsWe conducted a systematic review and meta-analysis of observational studies assessing the association between FB and mortality in adult ICU patients with sepsis or septic shock (PubMed, Scopus, CINAHL; through May 2024). Random-effects models estimated pooled odds ratios (ORs) for all-cause mortality; meta-regression explored dose-response patterns and heterogeneity. Risk of bias was assessed with ROBINS-E; certainty of evidence with GRADE.
resultsTwenty-six studies(64,755 patients) were included, most of which were retrospective with moderate-to-high risk of bias. Higher cumulative FB was associated with higher odds of mortality (OR 2.11, 95% CI 1.65-2.69). This association was consistent across different FB time windows and definitions; subgroup analyses did not identify study-level factors explaining heterogeneity. Meta-regression supported a linear dose-response relationship. No statistically significant association was observed between FB and the need for renal replacement therapy (OR 1.34, 95% CI 0.76-2.36). According to GRADE, the certainty of evidence was very low.
conclusionsAmong critically ill adults with sepsis or septic shock, higher fluid balance was associated with higher mortality. These observational associations are vulnerable to confounding by illness severity, precluding causal inference. Given the very low certainty of evidence, standardised definitions of fluid balance and randomised trials are needed. Potential differences between sepsis and septic shock warrant shock-status stratification.
trial registrationPROSPERO CRD42024538393.
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