No Association Between Readmission, Positive Fluid Balance at Discharge for Patients With Sepsis

Illustration of rod-shaped bacteria in a blood vessel with red blood cells and leukocytes.
Investigators evaluated the relationship between positive fluid balance among non-critically ill patients with sepsis and risk for hospital readmission.

For non-critically ill patients with sepsis, positive fluid balance at time of discharge was not found to be associated with hospital readmission, according to study results published in JAMA Network Open.

Researchers conducted a retrospective cohort study among 57,032 non-critically ill patients hospitalized for sepsis across 21 hospitals in Northern California. The cohort had a mean age of 73.7 years (SD 15.5) and was equally divided among men and women. Intake and output net fluid balance was measured daily and cumulatively at discharge.

At discharge, 40,940 (71.8%) patients had a positive net fluid balance and the remaining 16,092 (28.2%) had a negative net fluid balance. Patients with a negative balance at discharge were sicker than those in the positive balance group based on higher acute (Laboratory-Based Acute Physiology Score, version 2 [LAPS2]) and chronic (Comorbidity Point Score, version 2 [COPS2] and Charlson Comorbidity Index) severity of illness (mean LAPS2 93.8, SD 31.8 vs 90.8, SD 34.1; P <.001; mean COPS2 67.0, SD 46.3 vs 53.1, SD 43.4; P <.001; and mean Charlson Comorbidity Index 1.5, SD 1.5 vs 1.1 SD 1.3; P <.001). Patients with negative fluid balance also had significantly higher rates of pre-existing heart failure, chronic kidney disease, higher readmission risk score, lower median volumes of intravenous fluid administration, increased diuretic use, and longer mean length of hospital stay (P <.001 for all).

Throughout the 30-day follow-up period, 8719 patients (15.3%) were readmitted, and 3639 patients (6.4%) died. There was no difference in 30-day readmission risk between patients with positive and negative fluid balance, and there was no detectable association between fluid balance at discharge and hospital readmission. Having a positive fluid balance was associated with lower heart failure-related readmission (hazard  ratio [HR] 0.80, 95% CI, 0.71-0.91), higher infection-related readmission (HR 1.20, 95% CI, 1.09-1.33), and higher 30-day mortality (adjusted HR 1.23, 95% CI, 1.15-1.31) compared with patients with a negative fluid balance.

The study was limited by difficulties in obtaining true, reliable measures of fluid intake and output during hospitalization and fluid balance being only a partial indicator of intravascular volume status.  Data on patients transferring out of the health care system, outpatient interventions, and intravenous fluid type were limited, incomplete, or absent, and there were concerns about residual confounding having an impact on the study results.

Although the investigators found no association between increased risk for hospital readmission and net positive fluid balance in this patient population, they conclude, “Further studies are needed to examine the association of fluid status with outcomes in patients with sepsis to reduce the risk of readmission.”

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Yoo MS, Zhu S, Lu Y, et al. Association of positive fluid balance at discharge after sepsis management with 30-day readmission. JAMA Netw Open. 2021;4(6):e216105. doi: 10.1001/jamanetworkopen.2021.6105.