Comparison of 30-days mortality rates among Septic shock patients receiving intravenous fluids therapy greater than 1,500 mL versus with or less than 1,500 mL

Abstract

Objectives : Septic shock is the leading cause of death in Nakhon-Phanom province, Thailand. One in the medical treatment that has been recognized as the most useful treatment is the rapid, suitable, and sufficient intravenous (IV) fluids therapy. The previous studies reveal that the standard guidelines recommend starting the IV fluids therapy within 1 hour by the taking rate of 30 mL per 1 Kilogram of body weight or equally 1,500 mL per 50 Kilogram of body weight; however, there is no clear empirical evidence. This study aimed to compare the 30-days mortality rates among septic shock patients delivering IV fluids therapy greather than 1,500 mL (> 1,500 mL) vs with or less than 1,500 mL (≤ 1,500 mL) Material and methods : This therapeutic research study was conducted as a retrospective cohort design to collect all information in medical record retrospectively among septic shock patients who presented at emergency room(ER) of Nakhon-Phanom hospital between October 2016 and July 2017. Patients were divided into 2 groups; a) Septic shock patients who received IV fluids ≤ 1,500 mL and b) Septic shock patients who received IV fluids > 1,500 mL. The demographic, clinical and laboratory characteristics were compared using t-test and exact probability test. The mortality rates, Length of stay (LOS) and patient treatment costs (Costs) also compared by the multivariable Poisson regression. Additionally, the survival curve from Cox’s model was using to analyze the 30-days mortality rates as well. This study was approved by an ethic committee of Nakhon-Phanom hospital Results : There were 268 septic shock patients delivered at ER department; divided into 107 septic shock patients receiving IV fluids therapy ≤1,500 mL and 161 septic shock patients receiving IV fluids therapy > 1,500 mL. Patients characteristics of both groups were similar for gender, underlying diseases including Diabetes mellitus, Dyslipidemia, Gout, Liver disease, Heart disease, Lung disease, HIV infection, Malignancy, sources of infection, an inotropes/vasopressors and adjusted RW but slightly different for age and underlying disease including Hypertension, Chronic kidney disease and Hematological disease (Thalassemia) and laboratory characteristics including hematocrit, blood urea nitrogen, and creatinine. For the patient’s outcomes; LOS and Costs had no statistical different (p-value = 0.081 and 0.056, respectively) whereas there were statistical different on the 30-days mortality rates (95%CI: 0.30, 0.70, p < 0.001). After an adjusted effect, the 30-days mortality rates of septic shock patients who receiving IV fluids therapy > 1,500 mL had lower than the septic shock patients who receiving IV fluids therapy ≤ 1,500 mL Conclusion : This finding suggests that every septic shock patients with or without an underlying disease should be obtained an IV fluids therapy > 1,500 mL. However, should be considered harmoniously with patients assessment at delivered times, patient’s pathology, underlying disease and patients assessment during the IV fluids therapy