Race modifies the effect of fluid administration on mortality and long-term functional outcomes after Acute Respiratory Distress Syndrome

Abstract

Rationale: Conservative fluid management in ARDS contributes to more ventilator-free days, but no difference in 60-day mortality. Effects of ICU fluid strategies on longer-term mortality and morbidity in different racial subgroups remains unstudied. Objectives: Determine whether one-year mortality differ by fluid-strategy and race and whether functional dependence after ARDS differs by race. Methods/Measurements: Secondary analysis of data obtained during the ARDS Network Fluid and Catheter Treatment Trial (FACTT) and the Economic Analysis of Pulmonary Artery Catheters (EAPAC) study. Telephone interviews were conducted at 2, 6, 9 and 12 months after ARDS to determine survival and quality of life. Cox proportional hazards regression was used to investigate one-year mortality and logistic regression to investigate race and functional dependence with adjustment for age, sex and severity of illness. Main Results: A total of 582 participants who were enrolled in EAPAC including 475 alive at discharge were included with median follow-up of 336 days. One-year mortality differed significantly by fluid management and race (interaction p = 0.005). Among black participants, compared with conservative fluids, liberal fluids were associated with greater one-year mortality (HR 2.9, 95% CI 1.6-5.2, p=0.001) whereas among white participants, compared with conservative fluids, liberal fluids was associated with lesser mortality (HR 0.4, 95% CI 0.28-0.62) in adjusted analyses. Post-hospital functional dependence was worse in blacks compared with whites (OR: 2.3, 95% CI: 1.1-4.6, p=0.02). Conclusions: Secondary analysis of participants with one-year follow up after the FACTT found that there was a significant interaction between liberal fluid administration and race with suggesting liberal fluid administration may be harmful to black patients yet beneficial to white patients with ARDS.