Impact of the Magnitude and Timing of Fluid Overload on Outcomes in Critically Ill Children: A Report From the Multicenter International Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology (AWARE) Study
With the recognition that fluid overload (FO) has a detrimental impact on critically ill children, the critical care nephrology community has focused on identifying clinically meaningful targets for intervention. The current study aims to evaluate the epidemiology and outcomes associated with FO in...
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| Published in: | Critical care medicine Vol. 51; no. 5; p. 606 |
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| Main Authors: | , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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01.05.2023
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| ISSN: | 1530-0293, 1530-0293 |
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| Abstract | With the recognition that fluid overload (FO) has a detrimental impact on critically ill children, the critical care nephrology community has focused on identifying clinically meaningful targets for intervention. The current study aims to evaluate the epidemiology and outcomes associated with FO in an international multicenter cohort of critically ill children. The current study also aims to evaluate the association of FO at predetermined clinically relevant thresholds and time points (FO ≥ 5% and FO ≥ 10% at the end of ICU days 1 and 2) with outcomes.
Prospective cohort study.
Multicenter, international collaborative of 32 pediatric ICUs.
A total of 5,079 children and young adults admitted consecutively to pediatric ICUs as part of the Assessment of the Worldwide Acute Kidney Injury, Renal Angina and Epidemiology Study.
None.
The FO thresholds at the time points of interest occurred commonly in the cohort (FO ≥ 5%Day1 in 38.1% [ n = 1753], FO ≥ 10%Day1 in 11.7% [ n = 537], FO ≥ 5%Day2 in 53.3% [ n = 1,539], FO ≥ 10%Day2 in 25.1% [ n = 724]). On Day1, multivariable modeling demonstrated that FO ≥ 5% was associated with fewer ICU-free days, and FO ≥ 10% was associated with higher mortality and fewer ICU and ventilator-free days. On multivariable modeling, FO-peak, Day2 FO ≥ 5%, and Day2 FO ≥ 10% were associated with higher mortality and fewer ICU and ventilator-free days.
This study found that mild-to-moderate FO as early as at the end of ICU Day1 is associated with adverse outcomes. The current study fills an important void in the literature by identifying critical combinations of FO timing and quantity associated with adverse outcomes (FO ≥ 5%Day1, FO ≥10%Day1, FO ≥ 5%Day2, and FO ≥ 10%Day2). Those novel findings will help guide the development of interventional strategies and trials targeting the treatment and prevention of clinically relevant FO. |
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| AbstractList | With the recognition that fluid overload (FO) has a detrimental impact on critically ill children, the critical care nephrology community has focused on identifying clinically meaningful targets for intervention. The current study aims to evaluate the epidemiology and outcomes associated with FO in an international multicenter cohort of critically ill children. The current study also aims to evaluate the association of FO at predetermined clinically relevant thresholds and time points (FO ≥ 5% and FO ≥ 10% at the end of ICU days 1 and 2) with outcomes.
Prospective cohort study.
Multicenter, international collaborative of 32 pediatric ICUs.
A total of 5,079 children and young adults admitted consecutively to pediatric ICUs as part of the Assessment of the Worldwide Acute Kidney Injury, Renal Angina and Epidemiology Study.
None.
The FO thresholds at the time points of interest occurred commonly in the cohort (FO ≥ 5%Day1 in 38.1% [ n = 1753], FO ≥ 10%Day1 in 11.7% [ n = 537], FO ≥ 5%Day2 in 53.3% [ n = 1,539], FO ≥ 10%Day2 in 25.1% [ n = 724]). On Day1, multivariable modeling demonstrated that FO ≥ 5% was associated with fewer ICU-free days, and FO ≥ 10% was associated with higher mortality and fewer ICU and ventilator-free days. On multivariable modeling, FO-peak, Day2 FO ≥ 5%, and Day2 FO ≥ 10% were associated with higher mortality and fewer ICU and ventilator-free days.
This study found that mild-to-moderate FO as early as at the end of ICU Day1 is associated with adverse outcomes. The current study fills an important void in the literature by identifying critical combinations of FO timing and quantity associated with adverse outcomes (FO ≥ 5%Day1, FO ≥10%Day1, FO ≥ 5%Day2, and FO ≥ 10%Day2). Those novel findings will help guide the development of interventional strategies and trials targeting the treatment and prevention of clinically relevant FO. With the recognition that fluid overload (FO) has a detrimental impact on critically ill children, the critical care nephrology community has focused on identifying clinically meaningful targets for intervention. The current study aims to evaluate the epidemiology and outcomes associated with FO in an international multicenter cohort of critically ill children. The current study also aims to evaluate the association of FO at predetermined clinically relevant thresholds and time points (FO ≥ 5% and FO ≥ 10% at the end of ICU days 1 and 2) with outcomes.OBJECTIVESWith the recognition that fluid overload (FO) has a detrimental impact on critically ill children, the critical care nephrology community has focused on identifying clinically meaningful targets for intervention. The current study aims to evaluate the epidemiology and outcomes associated with FO in an international multicenter cohort of critically ill children. The current study also aims to evaluate the association of FO at predetermined clinically relevant thresholds and time points (FO ≥ 5% and FO ≥ 10% at the end of ICU days 1 and 2) with outcomes.Prospective cohort study.DESIGNProspective cohort study.Multicenter, international collaborative of 32 pediatric ICUs.SETTINGMulticenter, international collaborative of 32 pediatric ICUs.A total of 5,079 children and young adults admitted consecutively to pediatric ICUs as part of the Assessment of the Worldwide Acute Kidney Injury, Renal Angina and Epidemiology Study.PATIENTSA total of 5,079 children and young adults admitted consecutively to pediatric ICUs as part of the Assessment of the Worldwide Acute Kidney Injury, Renal Angina and Epidemiology Study.None.INTERVENTIONSNone.The FO thresholds at the time points of interest occurred commonly in the cohort (FO ≥ 5%Day1 in 38.1% [ n = 1753], FO ≥ 10%Day1 in 11.7% [ n = 537], FO ≥ 5%Day2 in 53.3% [ n = 1,539], FO ≥ 10%Day2 in 25.1% [ n = 724]). On Day1, multivariable modeling demonstrated that FO ≥ 5% was associated with fewer ICU-free days, and FO ≥ 10% was associated with higher mortality and fewer ICU and ventilator-free days. On multivariable modeling, FO-peak, Day2 FO ≥ 5%, and Day2 FO ≥ 10% were associated with higher mortality and fewer ICU and ventilator-free days.MEASUREMENTS AND MAIN RESULTSThe FO thresholds at the time points of interest occurred commonly in the cohort (FO ≥ 5%Day1 in 38.1% [ n = 1753], FO ≥ 10%Day1 in 11.7% [ n = 537], FO ≥ 5%Day2 in 53.3% [ n = 1,539], FO ≥ 10%Day2 in 25.1% [ n = 724]). On Day1, multivariable modeling demonstrated that FO ≥ 5% was associated with fewer ICU-free days, and FO ≥ 10% was associated with higher mortality and fewer ICU and ventilator-free days. On multivariable modeling, FO-peak, Day2 FO ≥ 5%, and Day2 FO ≥ 10% were associated with higher mortality and fewer ICU and ventilator-free days.This study found that mild-to-moderate FO as early as at the end of ICU Day1 is associated with adverse outcomes. The current study fills an important void in the literature by identifying critical combinations of FO timing and quantity associated with adverse outcomes (FO ≥ 5%Day1, FO ≥10%Day1, FO ≥ 5%Day2, and FO ≥ 10%Day2). Those novel findings will help guide the development of interventional strategies and trials targeting the treatment and prevention of clinically relevant FO.CONCLUSIONSThis study found that mild-to-moderate FO as early as at the end of ICU Day1 is associated with adverse outcomes. The current study fills an important void in the literature by identifying critical combinations of FO timing and quantity associated with adverse outcomes (FO ≥ 5%Day1, FO ≥10%Day1, FO ≥ 5%Day2, and FO ≥ 10%Day2). Those novel findings will help guide the development of interventional strategies and trials targeting the treatment and prevention of clinically relevant FO. |
| Author | Askenazi, David J Basu, Rajit K Gist, Katja M Goldstein, Stuart L Akcan-Arikan, Ayse Selewski, David T Gorga, Stephen M Mammen, Cherry Zappitelli, Michael Ricci, Zaccaria Woroniecki, Robert Soranno, Danielle E Gillespie, Scott E Sutherland, Scott M |
| Author_xml | – sequence: 1 givenname: David T surname: Selewski fullname: Selewski, David T organization: Division of Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC – sequence: 2 givenname: Katja M surname: Gist fullname: Gist, Katja M organization: Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH – sequence: 3 givenname: Rajit K surname: Basu fullname: Basu, Rajit K organization: Ann & Robert Lurie Children's Hospital of Chicago/Northwestern University School of Medicine, Chicago, IL – sequence: 4 givenname: Stuart L surname: Goldstein fullname: Goldstein, Stuart L organization: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH – sequence: 5 givenname: Michael surname: Zappitelli fullname: Zappitelli, Michael organization: Division of Nephrology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada – sequence: 6 givenname: Danielle E surname: Soranno fullname: Soranno, Danielle E organization: Section of Pediatric Nephrology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN – sequence: 7 givenname: Cherry surname: Mammen fullname: Mammen, Cherry organization: Department of Pediatrics, Division of Nephrology, BC Children's Hospital, Vancouver, BC, Canada – sequence: 8 givenname: Scott M surname: Sutherland fullname: Sutherland, Scott M organization: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA – sequence: 9 givenname: David J surname: Askenazi fullname: Askenazi, David J organization: Department of Pediatrics, Division of Nephrology, Pediatric and Infant Center for Acute Nephrology (PICAN), University of Alabama at Birmingham, Birmingham, AL – sequence: 10 givenname: Zaccaria surname: Ricci fullname: Ricci, Zaccaria organization: Department of Health Science, University of Florence, Firenze, Italy – sequence: 11 givenname: Ayse surname: Akcan-Arikan fullname: Akcan-Arikan, Ayse organization: Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX – sequence: 12 givenname: Stephen M surname: Gorga fullname: Gorga, Stephen M organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI – sequence: 13 givenname: Scott E surname: Gillespie fullname: Gillespie, Scott E organization: Division of Critical Care Medicine, Department of Pediatrics, Emory University, Atlanta, GA – sequence: 14 givenname: Robert surname: Woroniecki fullname: Woroniecki, Robert organization: Division of Nephrology, Department of Pediatrics, Renaissance School of Medicine at Stonybrook Children's Hospital, Stony Brook, NY |
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| SubjectTerms | Acute Kidney Injury - epidemiology Acute Kidney Injury - therapy Child Critical Illness - epidemiology Critical Illness - therapy Heart Failure Humans Intensive Care Units, Pediatric Prospective Studies Water-Electrolyte Imbalance Young Adult |
| Title | Impact of the Magnitude and Timing of Fluid Overload on Outcomes in Critically Ill Children: A Report From the Multicenter International Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology (AWARE) Study |
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