Comorbidities, Weight-Based Initial Fluid Resuscitation, and Mortality in Patients With Sepsis
Authors' conclusion
In this cohort study of patients with community-onset sepsis, initial administration of 30 mL/kg or more of fluid was associated with lower 30-day mortality among patients who had either hypoperfusion or intermediate lactate elevation without severe cardiac or kidney comorbidities.
Study context
- Population
- Adults hospitalised for community-onset sepsis with an indication for fluid resuscitation (hypotension or lactate ≥18.0 mg/dL) within 3 h of arrival, 67 Michigan Hospital Medicine Safety Consortium hospitals, Dec 2021–Jan 2025
- Participants
- 25,481 adults · 67 hospitals
- Exposure
- ≥30 mL/kg vs <30 mL/kg fluid within 6 h of hospital arrival
- Outcome
- 30-day mortality across target populations (fluid indication × severe cardiac or kidney comorbidities)
- Follow-up
- 30 days
Methodological detailsmulticentre, weighted regression adjusted for patient characteristics
- Multicentre
- Weighted regression adjusted for patient characteristics
Main finding
As reported in the abstract
Adjusted 30-day mortality by target population (subgroup)
≥30 mL/kg vs <30 mL/kgAdjusted absolute difference, pp (95% CI)
Hypoperfusion without severe comorbidities (n=12 943): 26.0% [95% CI, 24.9%-27.2%] vs 30.4% [95% CI, 28.8%-32.0%]
−4.4(−6.1 to −2.7)
Intermediate lactate elevation without severe comorbidities (n=9974): 12.0% [95% CI, 10.6%-13.5%] vs 13.9% [95% CI, 12.9%-14.8%]
−1.8(−3.6 to −0.1)
Hypoperfusion with severe comorbidities (n=1741), not statistically significant: 34.7% [95% CI, 30.8%-38.6%] vs 38.8% [95% CI, 35.8%-41.8%]
−4.1(−9.0 to 0.8)
Observational data: associations, not effects.
Further findings
Fluid volume and mortality (restricted cubic spline models), hypoperfusion with severe comorbidities
- Spline models indicated decreasing mortality with fluid resuscitation of ≥30 mL/kg
Original publication
Comorbidities, Weight-Based Initial Fluid Resuscitation, and Mortality in Patients With Sepsis. JAMA Netw Open. Published 1 June 2026. doi:10.
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