• Vaeli ZadehAliAHoly Cross Health, Heart Failure Research Services, Fort Lauderdale, FL, United States of America; University of Miami at Holy Cross Hospital, Fort Lauderdale, FL, United States of America. Electronic address: axv1154@med.miami.edu., Alan Wong, Andrew Carl Crawford, Elias Collado, and Joshua M Larned.
• Holy Cross Health, Heart Failure Research Services, Fort Lauderdale, FL, United States of America; University of Miami at Holy Cross Hospital, Fort Lauderdale, FL, United States of America. Electronic address: axv1154@med.miami.edu.
• Am J Emerg Med. 2023 Nov 1; 73: 343934-39.

ObjectivesTo examine whether a fluid resuscitation strategy based on guidelines (at least 30 mL/kg IV crystalloids) vs. a restrictive approach with <30 mL/kg within three hours affects in-hospital mortality in patients with sepsis and a history of heart failure (HF).Data SourcesOn 03/07/2023, we searched Embase, PubMed, and Scopus for peer-reviewed papers and abstracts using the PRISMA guidelines.Study SelectionThe language was limited to English. Studies published since 2016 included if they had sepsis patients with a history of HF, or a subgroup of patients with HF, and in-hospital mortality data on these patients that did or did not meet the 30 mL/kg by 3 h (30 × 3) goal. Duplicate studies, studies that focused on a broader period than 3 h from the diagnosis of sepsis or without mortality breakdown for HF patients or with unrelated title/abstract, or without an IRB approval were excluded.Data ExtractionIn-hospital mortality data was taken from the final studies for HF patients with sepsis who did or did not meet the 30 × 3 goal.Data SynthesisThe meta-analysis was performed using the Review Manager 5.4 program with ORs as the effect measure. The ProMeta program version 3.0 was used to evaluate the publication bias. Egger's linear regression and Berg and Mazumdar's rank correlation was used to evaluate the publication bias. The result was visually represented by a funnel plot. To estimate the proportion of variance attributable to heterogeneity, the I2 statistic was calculated.ResultsThe search yielded 26,069 records, which were narrowed down to 4 studies. Compared to those who met the 30 × 3 goal, the <30 × 3 group had a significantly higher risk of in-hospital mortality (OR = 1.81, 95% CI = 1.13-2.89, P = 0.01).ConclusionsRestrictive fluid resuscitation increased the risk of in-hospital mortality in HF patients with sepsis. More rigorous research is required to determine the optimal fluid resuscitation strategy for this population.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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