Heart & lung : the journal of critical care · 2026
Post-norepinephrine fluid volume and clinical outcomes in septic shock: a landmark retrospective cohort analysis of MIMIC-IV.
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Orso Daniele, Spagnolello Ornella, Di Chiara Pier Mario, Angelini Filippo, Enrione Giulia, Simeoni Gabriele, Della Rocca Giorgio
Аннотация
BACKGROUND: Fluid administered after norepinephrine initiation may reflect both resuscitation decisions and evolving illness severity, making observational comparisons susceptible to confounding and reverse causation.
OBJECTIVES: To evaluate associations between fluid volume during the first 6 h after norepinephrine initiation and mortality and incident invasive ventilation.
METHODS: We reconstructed an adult MIMIC-IV cohort with coded sepsis and norepinephrine initiated during ICU hours 0-24. Eligibility required complete pre-norepinephrine physiology and initial norepinephrine rate, survival, and ICU observation through a 6-hour landmark. Fluid exposure was ≤1,000 versus >1000 mL. Stabilized inverse-probability weights were truncated at the 1st and 99th percentiles. Doubly adjusted logistic models used patient-clustered robust standard errors.
RESULTS: The cohort included 2696 ICU stays from 2493 patients; 1572 received ≤1,000 mL. Maximum weighted standardized mean difference was 0.033. Twenty-eight-day mortality occurred in 1117 stays. Lower-volume exposure was not associated with mortality (odds ratio 1.08, 95% CI 0.89-1.31; adjusted risks 42.6% versus 41.1%). Results were similar for other mortality analyses and thresholds. Among 1356 stays not ventilated at baseline, incident ventilation was not clearly associated with exposure (OR 0.77, 95% CI 0.53-1.13). The spline showed no dose-response association (p = 0.983).
CONCLUSION: After source-level cohort construction and expanded adjustment, post-norepinephrine fluid volume was not associated with mortality or incident invasive ventilation.
OBJECTIVES: To evaluate associations between fluid volume during the first 6 h after norepinephrine initiation and mortality and incident invasive ventilation.
METHODS: We reconstructed an adult MIMIC-IV cohort with coded sepsis and norepinephrine initiated during ICU hours 0-24. Eligibility required complete pre-norepinephrine physiology and initial norepinephrine rate, survival, and ICU observation through a 6-hour landmark. Fluid exposure was ≤1,000 versus >1000 mL. Stabilized inverse-probability weights were truncated at the 1st and 99th percentiles. Doubly adjusted logistic models used patient-clustered robust standard errors.
RESULTS: The cohort included 2696 ICU stays from 2493 patients; 1572 received ≤1,000 mL. Maximum weighted standardized mean difference was 0.033. Twenty-eight-day mortality occurred in 1117 stays. Lower-volume exposure was not associated with mortality (odds ratio 1.08, 95% CI 0.89-1.31; adjusted risks 42.6% versus 41.1%). Results were similar for other mortality analyses and thresholds. Among 1356 stays not ventilated at baseline, incident ventilation was not clearly associated with exposure (OR 0.77, 95% CI 0.53-1.13). The spline showed no dose-response association (p = 0.983).
CONCLUSION: After source-level cohort construction and expanded adjustment, post-norepinephrine fluid volume was not associated with mortality or incident invasive ventilation.