Heart Failure, Reduced Ejection Fraction Associated With Reduced Odds of IV Fluids

Preexisting heart failure with reduced ejection fraction (HFrEF) is common among individuals who experience septic shock and was found to be associated with reduced odds of receiving guideline-recommended intravenous (IV) fluids, according to a study published in JAMA Network Open.

In the study of 5278 individuals with community-onset sepsis, 17% had preexisting HFrEF, which was associated with a lower risk-adjusted odds of receiving 30 mL/kg of IV fluids within 6 hours of sepsis onset.

Investigators found that there was no association between HFrEF and in-hospital mortality. They found that approximately 25% of patients with HFrEF received fluids compared to 37% who did not have the preexisting condition, and in-hospital mortality was 12% and 13%, respectively.

The risk-adjusted mortality was not significantly different for both groups of patients and there was no interaction with IV fluid volume.

Investigators also found that there was no difference in the number of individuals with septic shock who received broad-spectrum antibiotics within 3 hours at 72% for those with HFrEF and 71% of those without. Additionally, there was no difference found in the serum lactate level measured within 3 hours for both groups at 54% and 58%, respectively.

Investigators also found that there was no difference among patients in the median duration of invasive mechanical ventilation at 4 days and 5 days, respectively.

The same was true for receipt of vasoactive medications for those with HFrEF at 32% and without at 31%, intensive care unit admission at 80% and 78%, respectively, and median hospital length of stay at 6.9 days and 7.1 days, respectively.

In addition to HFrEF, investigators found that higher presenting SOFA score, lower age, lower Elixhauser Comorbidity Index, and being a female were associated with increased odds of receiving guideline-recommended intravenous fluids.

The study was approved by the University of Pittsburgh Human Research Protection office, and all data were obtained with informed consent and deidentified. Electronic health record data from 11 community and academic hospitals at the University of Pittsburgh Medical Center was evaluated from January 1, 2013, and December 31, 2015.

Individuals were included if the adults were hospitalized for more than 24 hours, met Sepsis-3 criteria within the first 6 hours of presentation, and had transthoracic echocardiography performed between 1 and 365 days prior to presentation with sepsis.

The investigators used multivariable models to adjust for patient factors and sepsis severity.

The study limitations included unmeasured confounders in observational studies and changing clinical practice guidelines for IV fluid administration for sepsis during the study period. Additionally, the health care system was in a specific geographical location, so it might not apply to the United States as a whole.

Investigators said that many other factors could contribute to the patient outcomes, including the trajectory of ejection fraction changes, the cause of heart failure, and the presence of diastolic dysfunction.

Reference

Powell RE, Kennedy JN, Senussi MH, Barbash IJ, Seymour CW. Association between preexisting heart failure with reduced ejection fraction and fluid administration among patients with sepsis. JAMA Netw Open. 2022;5(10):e2235331. doi:10.1001/jamanetworkopen.2022.35331