Naslov
Importance of recognizing dehydration in medical Intensive Care Unit

Autori
Mackovic, M. ; Maric, N. ; Bakula, M.

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
36th International Symposium on Intensive Care and Emergency Medicine - Meeting Abstracts / - : Critical Care, 2016, 347-347

Skup
36th International Symposium on Intensive Care and Emergency Medicine

Mjesto i datum
Bruxelles, Belgija, 15.03.2016. - 18.03.2016

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
dehydration ; ICU ; hydration status ; mortality

Sažetak
Introductions: Dehydration is a relatively unrecognized disorder in medical ICU especially among older patients. Our aim was to determine the incidence of dehydration upon admission as well as the risk of developing dehydration during hospitalization and its effect on patient outcome. Moreover, several lab parameters were studied in order to assess the correlation to the diagnosis. Methods: All patients entering ICU in a 6 month period in 2015 were enrolled and screened for dehydration on day 1 and day 3 using clinical and lab parameters (BUN, Cr, BUN/Cr ratio, Hct, serum Na, urine specific gravity). BUN/Cr >20 was used as a diagnostic criteria. Serum osmolality was not used due to unconsistent eligibility. In total of 332 patients, 38 were excluded due to GI haemorrhage. Finally, 294 patients were included, M/F 152/142, median age 74. Statistical methods used were McNemar test (differences in dehydration on day 1 and day 3), binary logistic analysis (association of lab parameters with dehydration) and multivariate adjusted binary logistic regression model (outcome). Results: Of 294 patients 126 (42.9 %) were dehydrated upon admission. Dehydration clinically diagnosed at admission and defined by BUN/Cr >20 were significantly associated (McNemar test ; χ 2 = 42.01 ; n = 246 ; p < 0.001 ; ϕ =0.24). Dehydration was correctly clinically recognised in 45/126 (35.7 %). Patients with BUN/Cr >20 had 3 times higher odds to be accurately clinically diagnosed. No correlation could be found between dehydration and values of Hct, serum Na and urine specific gravity. Statistically significant positive association was demonstrated for BUN (OR = 1.08 ; 95 % CI 1.04-1.11 ; p < 0.001) and Cr (OR = 1.00 ; 95 % CI 1.00-1.00 ; p = 0.048). On day 3 133/249 (54.1 %) patients were dehydrated which represents significant increase (McNemar test, χ 2 with continuity correction = 7.01 ; n = 246 ; p = 0.008 ; ϕ = 0.45). Overall, dehydration at any point of stay was associated with adverse outcome (death) (ORadj = 2.45, 95%CI 1.38-4.34, p = 0.002). Conclusions: Dehydration is a common finding in ICU and can be clinically easily overlooked due to insensitivity of clinicians for milder forms of dehydration which could explain a relatively high rate of misclassification. Clinical and lab parameters are insufficient for diagnosis which is consistent with previous observations. According to these data, hydration status changes during ICU stay and it’s fluctuations are associated with increased mortality suggesting that maintaining an adequate hydration status is of core interest for patient outcome.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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