Early Goal Directed Sepsis Management in Patients with Heart Failure and Concomitant Chronic Kidney Disease

Abstract

Current guidelines recommend for the use of protocolized quantitative fluid resuscitation in patients with sepsis. Limited data is available regarding optimal fluid management in patients with sepsis and concomitant heart failure (HF) and/or chronic kidney disease (CKD). Methods: This is a single center retrospective cohort study of patients diagnosed with sepsis and concomitant HF and CKD (K-HF) between January of 2015 and December of 2018. The primary outcome includes all cause in-hospital mortality. Secondary outcomes include length of stay, requirement of intravenous diuretics, need for renal replacement therapy, and 30-day heart failure readmission rate. Results: This cohort of 1116 patients included 621/1116 (55.64%) men with a mean age of 76 ± 14 years (see Table I for baseline characteristics). A total of 383/1116 (34.31%) patients had K-HF and 733/1116 (65.68%) did not have K-HF. Patients with K-HF received an initial bolus intravenous fluid (IVF) administration of 1.63 liters vs. patients with non-K-HF and sepsis who received 1.77 liters (p=0.1766). Mortality was 121/383 (31.93%) for patients with K-HF vs. 199/733 (27.26%) for non-K-HF patients (p=0.1084). 30-day readmission was 56/383(15.73%) in patients with K-HF vs. 112/733 (16.62) in patients with non-K-HF. In patients with sepsis with K-HF 204 (53.54%) developed AKI vs. 327 (44.61%) in non-K-HF patients. Renal replacement therapy (RRT) was required in 90/383 (23.69%) in patients with K-HF vs 327/733(44.61%) in non-K-HF patients. Conclusion: EGDT in patients with sepsis and concomitant HF and CKD shows diverse morbidity, however, with similar mortality in this special population.