Effect of Change in Body Weight on Clinical Outcomes in Critically Ill Patients
Rajesh K Mishra, Aparna Pande, Rashmi Ramachandran, Anjan Trikha, Preet M Singh, Vimi Rewari
Body weight, Fluid balance, Intensive care unit, Mortality
Citation Information :
Mishra RK, Pande A, Ramachandran R, Trikha A, Singh PM, Rewari V. Effect of Change in Body Weight on Clinical Outcomes in Critically Ill Patients. Indian J Crit Care Med 2021; 25 (9):1042-1048.
Background: Intravenous fluid optimization is an essential component of managing patients in a critical care setting. A cumulative positive fluid balance is consistent with poor outcomes in patients admitted to the intensive care unit (ICU). The overall utility of net cumulative fluid balance as a surrogate for assessing fluid overload has been interrogated.
Materials and methods: This study was a prospective single-center observational study, which was done to correlate body weight changes with fluid balance in ICU patients and evaluate its impact on clinical outcomes. Inclusion criteria consisted of adult patients who were admitted to the critical care unit on specialized beds with integrated weighing scales between September 2017 and December 2018. The evaluation of the effect of changes in body weight on ICU survival was the primary objective of the study.
Results: We enrolled 105 patients in this study. The ICU mortality was 23.80% with non-survivors showing more weight gain than the survivors. Statistically significant weight gain was documented in the non-survivors on days 3 and 4 (1.9 vs 1.05; p = 0.0084 and 2.6 vs 1.6; p = 0.0030) of ICU admission. Non-survivors had greater cumulative positive fluid balance on fourth, fifth, and sixth days post-ICU admission when compared to survivors (3586 vs 1659 mL, p = 0.0322; 5418 vs 1255 mL, p = 0.0017; and 5430 vs 2305 mL p = 0.0264, respectively). In multivariate regression analysis, cumulative fluid balance did not correlate with days on mechanical ventilation or length of stay in ICU. Changes in body weight and cumulative fluid balance showed a good correlation.
Conclusion: In patients admitted to the ICU, weight gain on third and fourth days of admission is concordant with increased ICU mortality. Body weight changes were seen to correlate well with the cumulative fluid balance.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006;34(2):344–353. DOI: 10.1097/01.ccm.0000194725.48928.3a.
Duan C-Y, Zhang J, Wu H-L, Li T, Liu L-M. Regulatory mechanisms, prophylaxis and treatment of vascular leakage following severe trauma and shock. Military Med Res 2017;4:11. DOI: 10.1186/s40779-017-0117-6.
Malbrain MLNG, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther 2014;46(5):361–380. DOI: 10.5603/AIT.2014.0060.
Sakr Y, Rubatto Birri PN, Kotfis K, Nanchal R, Shah B, Kluge S, et al. Higher fluid balance increases the risk of death from sepsis: results from a large international audit. Crit Care Med 2017;45(3):386–394. DOI: 10.1097/CCM.0000000000002189.
Acheampong A, Vincent J-L. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care 2015;19(1):251. DOI: 10.1186/s13054-015-0970-1.
Patil VP, Salunke BG. Fluid overload and acute kidney injury. Indian J Crit Care Med 2020;24(Suppl. 3):S94–S97. DOI: 10.5005/jp-journals-10071-23401.
Reintam Blaser A, Regli A, De Keulenaer B, Kimball EJ, Starkopf L, Davis WA, et al. Incidence, risk factors, and outcomes of intra-abdominal hypertension in critically ill patients – a prospective multicenter study (IROI Study). Crit Care Med 2019;47(4):535–542. DOI: 10.1097/CCM.0000000000003623.
Basso F, Berdin G, Virzì GM, Mason G, Piccinni P, Day S, et al. Fluid management in the intensive care unit: bioelectrical impedance vector analysis as a tool to assess hydration status and optimal fluid balance in critically ill patients. Blood Purif 2013;36(3–4):192–199. DOI: 10.1159/000356366.
Perren A, Markmann M, Merlani G, Marone C, Merlani P. Fluid balance in critically ill patients. Should we really rely on it? Minerva Anestesiol 2011;77(8):802–811. PMID: 21730928.
Van Regenmortel N, Verbrugghe W, Roelant E, Van den Wyngaert T, Jorens PG. Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population. Intensive Care Med 2018;44(4):409–417. DOI: 10.1007/s00134-018-5147-3.
Davies H, Leslie G, Jacob E, Morgan D. Estimation of body fluid status by fluid balance and body weight in critically ill adult patients: a systematic review. Worldviews Evid Based Nurs 2019;16(6):470–477. DOI: 10.1111/wvn.12394.
Schneider AG, Baldwin I, Freitag E, Glassford N, Bellomo R. Estimation of fluid status changes in critically ill patients: fluid balance chart or electronic bed weight? J Crit Care 2012;27(6):745.e7–e12. DOI: 10.1016/j.jcrc.2011.12.017.
Köster M, Dennhardt S, Jüttner F, Hopf H-B. Cumulative changes in weight but not fluid volume balances reflect fluid accumulation in ICU patients. Acta Anaesthesiol Scand 2017;61(2):205–215. DOI: 10.1111/aas.12840.
You J-W, Lee SJ, Kim YE, Cho YJ, Jeong YY, Kim HC, et al. Association between weight change and clinical outcomes in critically ill patients. J Crit Care 2013;28(6):923–927. DOI: 10.1016/j.jcrc.2013.07.055.
Cox P. Insensible water loss and its assessment in adult patients: a review. Acta Anaesthesiol Scand 1987;31(8):771–776. DOI: 10.1111/j.1399-6576.1987.tb02662.x.
Messmer AS, Zingg C, Müller M, Gerber JL, Schefold JC, Pfortmueller CA. Fluid overload and mortality in adult critical care patients – a systematic review and meta-analysis of observational studies. Crit Care Med 2020;48(12):1862–1870. DOI: 10.1097/CCM.0000000000004617.
Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol 2016;17(1):109. DOI: 10.1186/s12882-016-0323-6.
Peacock WF, Soto KM. Current techniques of fluid status assessment. Contrib Nephrol 2010;164:128–142. DOI: 10.1159/000313726.
Manoj R, Kumarasami R, Joseph J, George B, Sivaprakasam M. Continuous weight monitoring system for ICU beds using air-filled mattresses/pads: a proof of concept. In: 2019 IEEE international symposium on medical measurements and applications (MeMeA). Istanbul, Turkey: IEEE; 2019. p. 1–5.
Tolstrup J, Brandstrup B. Clinical assessment of fluid balance is incomplete for colorectal surgical patients. Scand J Surg 2015;104(3):161–168. DOI: 10.1177/1457496914543978.
Eastwood GM. Evaluating the reliability of recorded fluid balance to approximate body weight change in patients undergoing cardiac surgery. Heart Lung J Crit Care 2006;35(1):27–33. DOI: 10.1016/j.hrtlng.2005.06.001.
Davies H, Leslie GD, Morgan D, Dobb GJ. A comparison of compliance in the estimation of body fluid status using daily fluid balance charting and body weight changes during continuous renal replacement therapy. Aust Crit Care 2019;32(2):83–89. DOI: 10.1016/j.aucc.2017.12.090.
Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006;354(24):2564–2575. DOI: 10.1056/NEJMoa062200.
Chittawatanarat K, Pichaiya T, Chandacham K, Jirapongchareonlap T, Chotirosniramit N. Fluid accumulation threshold measured by acute body weight change after admission in general surgical intensive care units: how much should be concerning? Ther Clin Risk Manag 2015;11:1097–1106. DOI: 10.2147/TCRM.S86409.
Myatchin I, Abraham P, Malbrain MLNG. Bio-electrical impedance analysis in critically ill patients: are we ready for prime time? J Clin Monit Comput 2020;34(3):401–410. DOI: 10.1007/s10877-019-00439-0.