Prognostic value of difference of fluid intake and excretion in elderly patients with septic shock during hospitalization
10.3760/cma.j.issn.1671-0282.2025.05.008
- VernacularTitle:住院期间入出液体量差对老年脓毒性休克患者预后评估价值
- Author:
Xiaozhou LI
1
;
Qianqian YIN
;
Guangkuo ZHAO
Author Information
1. 上海健康医学院附属周浦医院（上海市浦东新区周浦医院）急诊内科，上海 201318
- Keywords:
Difference of fluid intake and excretion during hospitalization;
Septic shock in elderly patients;
Prognosis assessment;
Determination of fluid volume
- From:
Chinese Journal of Emergency Medicine
2025;34(5):656-661
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effect of difference of fluid intake and excretion on the prognosis of elderly patients with septic shock during hospitalization in ICU, and to provide evidence for clinical assessment of the condition, prognosis prediction, and optimization of fluid resuscitation strategies during hospitalization.Methods:A retrospective cohort study was conducted, involving elderly septic shock patients admitted to the ICU of Zhoupu Hospital affiliated to Shanghai Health College from January 2018 to June 2024. Data on general characteristics, clinical parameters at 6 h and 24 h after ICU admission, and cumulative difference of fluid intake and excretion during ICU stay were collected. Patients were divided into survival group and death group based on whether they survived during hospitalization. Differences in study variables between groups were analyzed. Logistic regression analysis was performed on the independent risk factors of the mortality rate during hospitalization. Receiver operating characteristic (ROC) was plotted to evaluate the prognostic value of difference of fluid intake and excretion in elderly patients with septic shock during hospitalization in ICU.Results:A total of 159 elderly septic shock patients were included (108 males, 51 females), with an in-hospital mortality rate of 66.66% (106 deaths vs. 53 survivors). Compared with the survival group, the difference of total fluid intake and excretion during hospitalization in ICU in the death group was significantly lower [2 441.00 (228.50, 5 101.50) mL vs. 6 215.50 (3 755.00, 9 874.75) mL, P<0.001]. Multivariate logistic regression analysis showed that SOFA score ( OR=1.359, 95% CI: 1.135-1.626, P=0.001) and the difference of total fluid intake and excretion during hospitalization in ICU ( OR=1.174, 95% CI: 1.067-1.291, P=0.001) were independent risk factors for predicting prognosis during hospitalization. ROC analysis revealed that the cumulative difference of fluid intake and excretion achieved an AUC of 0.756 (95% CI: 0.674-0.838, P<0.001), with a sensitivity of 61.8% and specificity of 82.4% at a cutoff value of ≥5 396.5 mL. In addition, AUC of the total fluid intake and excretion difference and SOFA score during hospitalization in ICU was 0.885 (95% CI: 0.825-0.944, P<0.001). Conclusions:A higher cumulative difference of fluid intake and excretion during ICU hospitalization is associated with increased mortality in elderly septic shock patients. A positive difference of fluid intake and excretion may serve as a clinical indicator for predicting prognosis of elderly patients with septic shock.
