CC:重症医学科收治的心脏骤停患者液体平衡与预后的相关性

Abstract

Background

Although shock following cardiac arrest is common and contributes significantly to mortality, the influence of the modalities used to manage the hemodynamic situation, particularly with regard to fluid balance, remains unclear. We evaluated the association between positive fluid balance and outcome after out-of-hospital cardiac arrest (OHCA).
尽管心脏骤停后的休克很常见，且死亡率显著增加，但血流动力学管理方式（尤其是液体平衡）的影响仍不明确。本研究评估了院外心脏骤停（OHCA）患者液体正平衡与预后的关联。

Methods

We conducted a multicenter study from August 2020 to June 2022, which consecutively enrolled adult OHCA patients in 17 intensive care units. The primary endpoint was 90-day survival. Multivariate Cox analysis, propensity score matching and landmark analysis were performed, along with several sensitivity analyses.

于2020年8月至2022年6月在17个重症监护病房（ICU）开展了一项多中心研究纳入成年OHCA患者。主要终点为90天生存率，采用多变量Cox分析、倾向评分匹配、特征分析以及多项敏感性分析等方法。

Results

Of the 816 patients included in our study, 74% had a positive fluid balance, and 291 of 816 patients (36%) were alive at 90-day. A positive fluid balance was associated with mortality after adjusted multivariate analysis (HR = 1.8 [1.3 – 2.3], p < 0.001), after propensity score matching (n = 193 matched patient pairs, HR = 1.6 [1.1 – 2.1], p = 0.005) and after landmark analysis. We reported a dose-dependent association between fluid balance and mortality. Patients with a positive fluid balance were more likely to need renal replacement therapy (10% vs. 2%, p = 0.001) and had a lower minimum P_aO₂/F_iO₂ ratio in the first seven days (158 vs. 180, p < 0.001).

816例患者中，74%存在液体正平衡，90天生存率为36%（291/816）。调整多变量分析显示，液体正平衡与死亡率显著相关（HR=1.8 [1.3–2.3], p<0.001），倾向评分匹配（193对患者，HR=1.6 [1.1–2.1], p=0.005）和特征分析结果一致。液体正平衡患者更需肾脏替代治疗（10% vs. 2%, p=0.001），且7天内最低氧合指数更低（158 vs. 180, p<0.001）。

Conclusions

After cardiac arrest, a positive fluid balance is consistently associated with a worse outcome. Pending further data, a restrictive fluid therapy strategy may be beneficial in post-OHCA patients.

心脏骤停后液体正平衡与不良预后显著相关。在进一步数据支持前，限制性液体治疗策略可能对OHCA患者更有益。

Trial registration: ClinicalTrial.gov cohort AfterROSC-1 NCT04167891 registered November 13th, 2019, ethics committees 2019-A01378-49 and CPP-SMIV 190901.