(1568) Association of Noninvasive Bioreactance Monitoring With Hospital Mortality in Adults With Sepsis

Introduction: The effectiveness of accurate non-invasive hemodynamic monitoring with bioreactance (NICOM) to monitor stroke volume in usual care has not been reported. Continuous SV monitoring may facilitate dynamic measurement of fluid responsiveness that has been recommended by the Surviving Sepsis Campaign. This study compared Sepsis and Septic Shock outcomes with and without this technology using the 2016-2019 Premier Healthcare Database (PHD).

Methods: A total of 190,682 sepsis patients presented at the ED and were admitted to ICU on day 1 at 612 hospitals in 2016-19 PHD. Hospitals with fewer than 300 patients or a transfer rate above 10% were excluded. Three hospitals with at least 10% Bioreactance (NICOM) use on day-1, identified by NICOM-specific charge codes, were included in analysis. Outcomes of interest were day 3 and overall hospital mortality, ICU and hospital LOS and total cost in patients with and without day-1 NICOM. Risk adjusted day 3 and hospital mortality models were built using present on admission conditions (demographics, acute organ dysfunctions and comorbidities). These models were used to risk adjust differences between patients by NICOM use.

Results: There were 2,120 patients in the analysis data set, 364 received NICOM Day-1 (NiG) (17.1%). NiG patients had a risk adjusted 3-day mortality rate 3.4% lower (p < 0.001) and overall hospital mortality 4.7% lower (p=0.0007) compared to non NICOM group (NNiG). The difference in hospital mortality for high-risk patients (above median risk) was even greater at 7.1% (p=0.001). The mean ICU LOS was 1.4 day shorter for NiG (p < 0.001) and hospital LOS 1.0 day shorter (p=0.024). Average hospital cost was $1,602 lower for NiG patients, but due to variations in cost and small sample size this difference was not significant (p=0.481).

Conclusions: NICOM use remains infrequent in usual care. Day-1 NICOM hemodynamic monitoring in Sepsis and Septic Shock patients is associated with lower 3-day and overall mortality, especially in high-risk patients, as well as shorter hospital and ICU length of stay. The mechanisms for improved outcomes with NICOM hemodynamic monitoring warrant additional analysis.