Fluid Imbalance Doubles Odds of ICU Stay in Patients With Infections


In Fluid Imbalance

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By: James Pitt  Jun. 25, 2018

Fluid balance is a measure of whether a patient has excess, or insufficient, fluid relative to electrolytes. Dexur has previously examined the effects of fluid imbalance in sepsis, a well-studied topic.

Dexur analysts conducted an exploratory analysis of how fluid imbalance affects the odds of ICU stays. Analysts examined five diagnosis-related groups (DRGs):

The sample included hospital-level data from Arkansas hospitals with over 5,000 CMS inpatient discharges per year. For each of these DRGs, at least eight hospitals reported the percentages of patients with and without ICU stays with and without fluid imbalance.

Fluid imbalance is a classic feature of heart failure, associated with adverse outcomes. In particular, congestive heart failure involves fluid overload when the kidneys retain water in response to hemodynamic changes. At St. Bernard's Medical Center (Jonesboro, AR), the odds ratio of ICU stay with vs without fluid imbalance was 2.59. In other words, 2.59 patients with heart failure with major complications and fluid imbalance would have an ICU stay for every 1 patient with heart failure with MCC without fluid imbalance who had an ICU stay. At St. Vincent Hot Springs (Hot Springs, AR), the odds ratio was only 1.09, indicating fluid imbalance had very little effect on ICU stays in heart failure patients here.

DRG 291 Odds Ratio of ICU Stay With vs Without Fluid Imbalance Arkansas Hospitals

Because fluid balance in heart failure relates to the renal system, it may be unsurprising that the effects of fluid imbalance in renal failure followed a similar distribution. The lowest odds ratio was 1.05 at NEA Baptist Memorial Hospital (Jonesboro), and the highest 1.97 at Sparks Health System (Fort Smith).

Fluid imbalance had a consistent effect on odds of ICU stay in bowel surgery patients. The optimal fluid therapy to prevent such outcomes is a much-debated topic in colorectal surgery. Two allied hospitals in Little Rock had the highest and lowest odds ratios of ICU stay with vs without fluid imbalance in bowel surgery patients. St. Vincent Hot Springs had the lowest odds ratio at 1.46, while St. Vincent Infirmary Medical Center had the highest at 3.34.

UAMS Hospital had an unusually high odds ratio of ICU stay with vs without fluid imbalance among patients with major infections. Its total number of DRG 853 patients and percent of DRG 853 patients with fluid imbalances were comparable to other Little Rock hospitals, so this may reflect a policy difference rather than a difference in its patient population.

Fluid imbalance in sepsis is a topic Dexur has discussed extensively in other states.

DEXUR PRO MEMBERS GET ACCESS TO:

  1. Total DRG Discharges
  2. Percentage of discharges at DRG with ICU Stay Without Fluid Imbalance
  3. Percentage of discharges at DRG with ICU Stay With Fluid Imbalance
  4. Difference in ICU Stay % with vs without Fluid Imbalance
  5. ICU stay odds if fluid imbalance
  6. ICU stay odds if no fluid imbalance
  7. Odds Ratio of ICU stay odds with vs without fluid imbalance

At DRG level, for DRG 291, DRG 329, DRG 682, DRG 853, and DRG 871, from 2013-2016, for the following hospitals:

  1. St Vincent Infirmary Medical Center
  2. Sparks Health System
  3. UAMS Hospital
  4. St Bernards Medical Center
  5. Mercy Hospital Fort Smith
  6. St Vincent Hot Springs
  7. Washington Regional Medical Center At North Hills
  8. Unity Health - White County Medical Center
  9. NEA Baptist Memorial Hospital
  10. Baptist Health Medical Center North Little Rock


ABOUT THE AUTHOR

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James Pitt

James Pitt is a science writer with experience in medical devices and textbook publishing. His hobbies include reading, flintknapping, and squinting at RStudio. He received a bachelor's in Human Evolutionary Biology from Harvard.