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Original article
Mortality in adult patients with fluid overload evaluated by BIVA upon admission to the emergency department
  1. Ashuin Kammar-García1,2,
  2. Ziv Pérez-Morales1,
  3. Lilia Castillo-Martinez3,
  4. José Luis Villanueva-Juárez3,
  5. Fernanda Bernal-Ceballos1,
  6. Héctor Isaac Rocha-González2,
  7. Miguel Remolina-Schlig1,
  8. Thierry Hernández-Gilsoul4
  1. 1Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
  2. 2Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
  3. 3Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
  4. 4Critical Care Division, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
  1. Correspondence to Dr Thierry Hernández-Gilsoul, Critical Care Division, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México CP 14080, México; doctorthierry{at}hotmail.com

Abstract

Purpose of the study The aim of this study was to investigate the association of fluid overload, measured by bioelectrical impedance vector analysis (BIVA) and also by accumulated fluid balance, with 30-day mortality rates in patients admitted to the emergency department (ED).

Design We conducted a prospective observational study of fluid overload using BIVA, taking measures using a multiple-frequency whole-body tetrapolar equipment. Accumulated fluid balances were obtained at 24, 48 and 72 hours from ED admission and its association with 30-day mortality.

Patients 109 patients admitted to the ED classified as fluid overloaded by both methods.

Results According to BIVA, 71.6% (n=78) of patients had fluid overload on ED admission. These patients were older and had higher Sequential Organ Failure Assessment scores. During a median follow-up period of 30 days, 32.1% (n=25) of patients with fluid overload evaluated by BIVA died versus none with normovolaemia (p=0.001). There was no statistically significant difference in mortality between patients with and without fluid overload as assessed by accumulated fluid balance (p=0.81).

Conclusions Fluid overload on admission evaluated by BIVA was significantly related to mortality in patients admitted to the ED.

  • emergency medicine
  • nutrition
  • critical care
  • bioelectrical impedance vectorial analysis
  • fluid overload
  • mortality

http://dx.doi.org/10.1136/postgradmedj-2018-135695

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    Footnotes

    • Contributors AK-G contributed to writing the manuscript and analysed the data. ZP-M made the BIVA measurements and performed data collection. LC-M contributed to writing the manuscript and conduct of the study. JLV-J coordinated the BIVA measurements. FB-C made the BIVA measurements. HIR-G contributed to the methodology of the study. MR-S contributed to the structure of the article. TH-G contributed to writing the manuscript and planned the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study protocol was approved by the Research and Bioethics Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Author note This work is part of the MSc dissertation of Kammar-García A. He is also a CONACYT fellow (number: 619671).