The Impact of Fluid Management in Patients with Sepsis and Heart Failure

Background Current guidelines recommend 30cc/kg of intravenous fluid (IVF) early resuscitation for patients with suspected sepsis. However, IVF resuscitation is often delayed in patients with left ventricular dysfunction due to concern of worsening heart failure. There is limited data regarding outcomes in large volume IVF in this population with various degrees of left ventricular ejection fraction (LVEF). Methods This was a retrospective cohort study of patients with heart failure and sepsis admitted to a single cardiovascular center between January 2015 and December 2018. Heart failure was defined as preserved (EF > 50%), mid-range (40-50%), or reduced (EF Results A total of 979 patients with diagnosis of heart failure and sepsis were included in the analysis. There were 539 (55%) males and mean age was 75.4 ± 14.1. There were 590 (60.2%) patients with preserved EF, 87 (8.8%) patients with mid-range EF, and 302 (30.8%) with reduced EF. See Table 1 for baseline characteristics. There was no significant difference in amount of IVF received by either cohorts at encounter, 6 hours or 24 hours. Although not statistically significant, patients with mid-range EF appeared more likely to die during hospitalization. See Table 2 for outcomes. Conclusions This retrospective analysis suggests the mortality in patients with heart failure and sepsis was not affected by the degree of LVEF. Larger randomized trials are needed to further investigate the impact of IVF management in these patients.