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The Correspondence between Fluid Balance and Body Weight Change Measurements in Critically Ill Adult Patients

Ana Carolina Peçanha Antonio
Ana Carolina Peçanha Antonio
, 
Vivian Rodrigues Fernandes
Vivian Rodrigues Fernandes
 and 
Karina de Oliveira Azzolin
Karina de Oliveira Azzolin
   | Jan 29, 2021
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Article Category: Research Article
Published Online: Jan 29, 2021
Page range: 46 - 53
Received: Jun 23, 2020
Accepted: Dec 08, 2020
DOI: https://doi.org/10.2478/jccm-2020-0048
Keywords
© 2021 Ana Carolina Peçanha Antonio, Vivian Rodrigues Fernandes, Karina de Oliveira Azzolin, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1

Study flow.
Study flow.

Fig. 2

Bland Altman plot for changes in fluid balance and simultaneous body weight (A) Daily fluid balance and body weight changes. B) Daily fluid balance with indiscernible water loss and body weight changes. C) Cumulative FB and total body weight change. D) Cumulative fluid balance with indiscernible water loss and total body weight change. X-axis, mean values for fluid balance and body weight. Y- axis, difference between fluid balance and body weight.
Bland Altman plot for changes in fluid balance and simultaneous body weight (A) Daily fluid balance and body weight changes. B) Daily fluid balance with indiscernible water loss and body weight changes. C) Cumulative FB and total body weight change. D) Cumulative fluid balance with indiscernible water loss and total body weight change. X-axis, mean values for fluid balance and body weight. Y- axis, difference between fluid balance and body weight.

Fig. 3

Correlation between A) daily fluid balance and body weight changes (Spearman rank correlation; p< 0.001), B) daily fluid balance with indiscernible water loss and body weight changes (Spearman rank correlation; p< 0.001), C) cumulative fluid balance and total body weight change (Spearman rank correlation; p= 0.03), and D) cumulative fluid balance with indiscernible water loss and total body weight change (Spearman rank correlation; p< 0.001).
Correlation between A) daily fluid balance and body weight changes (Spearman rank correlation; p< 0.001), B) daily fluid balance with indiscernible water loss and body weight changes (Spearman rank correlation; p< 0.001), C) cumulative fluid balance and total body weight change (Spearman rank correlation; p= 0.03), and D) cumulative fluid balance with indiscernible water loss and total body weight change (Spearman rank correlation; p< 0.001).

Fig. 4

Areas under ROC curve showing discrimination power of cumulative fluid balance, cumulative fluid balance corrected for indiscernible water loss and total body weight change in predicting ICU mortality.
Areas under ROC curve showing discrimination power of cumulative fluid balance, cumulative fluid balance corrected for indiscernible water loss and total body weight change in predicting ICU mortality.

Characteristics of the study cohort

All patients Survivors Non-survivors p Value
(n = 94) (n= 64) (n= 30)
Age; years (SD) I 57.36 (17.20) 57.83(17.92) 56.37 (15.78) 0.70
Female gender (%) 48 (51.06) 32 (50) 16 (53.3) 0.83
SAPS3; points (SD) 69.03 (18.46) 67.78 (16.17) 71.67 (22.60) 0.34
BMI; kg/m2 (SD) 27.81 (7.25) 28.54 (7.49) 26.26 (6.54) 0.16
Origin (%)
           Emergency room 47 (50) 34 (53.12) 13 (43.33) 0.35
           Hospital ward 34 (36.17) 20 (31.25) 14 (46.67)
           Other hospital 13 (13.83) 10 (15.62) 3 (10)
Energy delivered on 3rd day of ICU stay; kcal/day (SD) 21.05 (6.47) 22.12 (6.42) 18.50 (5.98) 0.014
Protein delivered on 3rd day of ICU stay; g/kg (SD) 1.42 (0.52) 1.49 (0.44) 1.25 (0.65) 0.045
Comorbidities (%)
           COPD 13 (13.83) 9 (14.06) 4 (13.33) 1.0
           EF < 35% 11 (11.70) 8 (12.50) 3 (10) 1.0
           Cirrhosis 9 (9.57) 6 (9.38) 3 (10) 1.0
           Cancer 23 (24.47) 16 (25) 7 (23.33) 1.0
           End-stage renal disease 7 (7.45) 4 (6.25) 3 (10) 0.68
           Immunosuppression 15 (15.96) 8 (12.50) 7 (23.33) 0.23
Reason for ICU admission (%)
           Respiratory sepsis 29 (30.85) 18 (28.12) 11 (36.67)
           Non respiratory sepsis 7 (7.45) 3 (4.69) 4 (13.33)
           Cardiovascular disease 5 (5.32) 5 (7.81) 0 (0)
           Coma 18 (19.15) 11 (17.19) 7 (23.33) 0.13
           Postoperative ARF 7 (7.45) 4 (6.25) 3 (10)
           COPD/Asthma 3 (3.19) 2 (3.12) 1 (3.33)
           Pulmonary Embolism 2 (2.13) 1 (1.56) 1 (3.33)
           ARDS 23 (24.47) 20 (31.25) 3 (10)
Organ dysfunction at ICU admission*
           Hemodynamic 74 (78.72) 50 (78.12) 24 (80) 1.0
           Lung 86 (91.49) 59 (92.19) 27 (90) 0.71
           Renal 35 (37.23) 24 (37.5) 11 (36.67) 1.00
           Hematologic 25 (26.60) 13 (20.31) 12 (40) 0.078
           Liver 8 (8.33) 3 (4.55) 5 (16.67) 0.10
           Neurological 39 (41.49) 23 (35.94) 16 (53.33) 0.12
Diuretic provision during ICU stay (%)** 30 (31.91) 20 (31.25) 10 (33.33) 1.0
Need of RRT during ICU stay (%)** 32 (34.04) 16 (25) 16 (53.33) 0.010
ICU-acquired infection (%)** 25 (26.60) 12 (18.75) 13 (43.33) 0.023
MV duration (days)** 7 (3 – 10) 6 (2 – 9) 8 (6 – 13) 0.012
Length of ICU stay (days)** 9 (6 – 15) 9.5 (6 – 15.5) 8 (6 – 14) 0.87
Length of hospital stay (days)** 16 (9 – 27) 16 (9.5 – 28) 15.5 (8 – 27) 0.95
Time between hospitalization and ICU admission (days) 3 (1 – 10) 3 (1 – 9) 3 (1 – 10) 0.98

Comparison of fluid balance and weight change of survivors and non-survivors of ICU hospitalization

All patients* (n = 94) Survivors (n= 64) Non-survivors (n= 30) p Value
First 24h-fluid balance (L) +0.95 ([+0.09] – [+1.78]) +0.84 ([+0.08] – [+1.6]) +1.26 ([+0.41] – [+0.27]) 0.10
First 24h-fluid balance + +0.05 ([-0.79] – [+0.80]) -0.004 ([-0.88] – [+0.74]) +0.64 ([-0.48] – [+1.77]) 0.075
indiscernible water loss (L)
First 24h-weight change (kg) 0.0 ([-0.9] – [+1.1]) +0.25 ([-1.45] – [+0.6]) +0.9 ([-0.1] – [+2.2]) <0.001
Cumulative fluid balance (L) +3.61 ([-0.11] – [+7.43]) +2.53 ([-0.4] – [+6.0]) +5.6 ([+1.85] – [+9.21]) 0.012
Cumulative fluid balance + -3.89 ([-7.27] – [-0.1]) -3.91 ([-7.78] – [-1.1]) -3.33 ([-6.87] – [+0.97]) 0.37
indiscernible water loss (L)
Total weight change (kg) -2.55 ([-4.8] – [+0.1]) -3.05 ([-6.5] – [-0.7]) -1.1 ([-3.1] – [+0.9]) 0.008
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