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Fluid intake-related association between urine output and mortality in acute respiratory distress syndrome
- Source :
- Respiratory Research, Respiratory Research, Vol 21, Iss 1, Pp 1-8 (2020)
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- Background Acute respiratory distress syndrome (ARDS), a complex response to various insults, has a high mortality rate. As pulmonary edema resulting from increased vascular permeability is a hallmark of ARDS, management of the fluid status, including the urine output (UO) and fluid intake (FI), is essential. However, the relationships between UO, FI, and mortality in ARDS remain unclear. This retrospective study aimed to investigate the interactive associations among UO, FI, and mortality in ARDS. Methods This was a secondary analysis of a prospective randomized controlled trial performed at 10 centers within the ARDS Network of the National Heart, Lung, and Blood Institute research network. The total UO and FI volumes within the 24-h period preceding the trial, the UO to FI ratio (UO/FI), demographic data, biochemical measurements, and other variables from 835 patients with ARDS, 539 survivors, and 296 non-survivors, were analyzed. The associations among UO, FI, the UO/FI, and mortality were assessed using a multivariable logistic regression. Results In all 835 patients, an increased UO was significantly associated with decreased mortality when used as a continuous variable (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.98–0.99, P = 0.002) and as a quartile variable (OR of Q2 to Q4: 0.69–0.46, with Q1 as reference). To explore the interaction between UO and FI, the UO/FI was calculated, and a cut-off value of 0.5 was detected for the association with mortality. For patients with a UO/FI ≤0.5, an increased UO/FI was significantly associated with decreased mortality (OR: 0.09, 95% CI: 0.03–0.253, P 0.5 (OR: 1.04, 95% CI: 0.96–1.14, P = 0.281). A significant interaction was observed between UO and the UO/FI. The association between UO and mortality was significant in the subgroup with a UO/FI ≤0.5 (OR: 0.97, 95% CI: 0.96–0.99, P = 0.006), but not in the subgroup with a UO/FI > 0.5. Conclusions The association between UO and mortality was mediated by the UO/FI status, as only patients with low UO/FI ratios benefitted from a higher UO.
- Subjects :
- Adult
Male
medicine.medical_specialty
ARDS
Urination
030204 cardiovascular system & hematology
Logistic regression
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Internal medicine
Fluid management
medicine
Humans
Hospital Mortality
Prospective Studies
Fluid intake
Mortality
Urine output
Aged
Retrospective Studies
lcsh:RC705-779
Respiratory Distress Syndrome
Acute respiratory distress syndrome
business.industry
Research
Mortality rate
030208 emergency & critical care medicine
Retrospective cohort study
lcsh:Diseases of the respiratory system
Odds ratio
Middle Aged
Pulmonary edema
medicine.disease
Confidence interval
Quartile
Fluid Therapy
Female
business
Subjects
Details
- ISSN :
- 1465993X
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Respiratory Research
- Accession number :
- edsair.doi.dedup.....0ef56151cbcbfa69d4e23699c4c37684