Objective: We hypothesized that patients with septic
shock who achieve negative fluid balance (≤ −500 mL) on any day in
the first 3 days of management are more likely to survive than those
who do not.
Design: Retrospective chart review.
Patients: Thirty-six patients admitted with the diagnosis
of septic shock.
Setting: Twelve-bed medical ICU of a
300-bed community teaching hospital.
records of 36 patients admitted to our medical ICU over a 21-month
period were examined. Patients with septic shock who required dialysis
prior to hospitalization were not included. A number of demographic and
physiologic variables were extracted from the medical records.
Admission APACHE (acute physiology and chronic health evaluation) II
and daily sequential organ failure assessment (SOFA) scores were
computed from the extracted data. Variables were compared between
survivors and nonsurvivors and in patients who did vs those who did not
achieve negative (≤ 500 mL) fluid balance in ≥ 1 day of the first 3
days of management. Survival risk ratios (RRs) were used as the measure
of association between negative fluid balance and survival. RRs were
adjusted for age, APACHE II scores, SOFA scores on the first and third
days, and the need for mechanical ventilation, by stratified
Results: Patients ranged in age from 16 to
85 years with a mean (± SE) age of 67.4 ± 3.3 years. The mean
admission APACHE II score was 25.4 ± 1.4, and the day 1 SOFA score
was 9.0 ± 0.8. Twenty patients did not survive; nonsurvivors had
higher mean APACHE II scores than survivors (29.8 vs 20.4,
respectively) and higher first day SOFA scores than survivors (10.8 vs
6.9, respectively), and they were more likely to require
vasopressors and mechanical ventilation compared to patients who
survived. Whereas all 11 patients who achieved a negative balance of>
500 mL on ≥ 1 of the first 3 days of treatment survived, only 5
of 25 patient who failed to achieve a negative fluid balance of > 500
mL by the third day of treatment survived (RR, 5.0; 95% CI, 2.3 to
10.9; p = 0.00001). At least 1 day of net negative fluid balance in
the first 3 days of treatment strongly predicted survival across the
strata of age, APACHE II scores, first- and third-day SOFA scores, the
need for mechanical ventilation, and creatinine levels measured at
Conclusion: These results suggest that at
least 1 day of negative fluid balance (≤ −500 mL) achieved by the
third day of treatment may be a good independent predictor of survival
in patients with septic shock. These findings suggest the hypothesis“
that negative fluid balance achieved in any of the first 3 days of
septic shock portends a good prognosis,” for a larger
prospective cohort study.