Impact of Fluid Overload on Mortality Among Critically Ill Pediatric Patients: An Observational Study at a Tertiary Care Hospital in Central India

Background Fluid overload (FO) is a critical concern in pediatric intensive care units (PICUs), contributing to increased morbidity and mortality. Excessive fluid accumulation can exacerbate organ dysfunction, particularly affecting the cardiovascular, respiratory, and renal systems. While FO has been widely studied in adult populations, data on its burden, risk factors, and clinical outcomes in critically ill pediatric patients, particularly in low-resource settings like India, remain limited. This study aimed to assess the prevalence of significant cumulative FO percentage and its association with mortality, Pediatric Risk of Mortality (PRISM-III) score, and length of PICU stay. Methods This prospective observational study was conducted from June 2023 to October 2024 at the PICU of a tertiary care hospital in central India. A total of 230 children aged 1 month to 13 years who required intensive care were included. Demographic and clinical parameters, including fluid balance and PRISM-III scores, were recorded. FO was calculated based on cumulative fluid intake and output relative to baseline body weight. The association between FO and clinical outcomes was assessed using logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results The median (interquartile range (IQR)) cumulative FO at 24 hours, 48 hours, 7 days, and cumulative FO were 5.4% (3.4, 7.8), 5.3% (3.5-8), 5.7% (3.7-8.3), and 5.7% (3.7-8.4), respectively. The median PRISM-III score was 6 (IQR: 0-14). Among the 230 children, 13% died during follow-up. Non-survivors had significantly higher PRISM-III scores and FO percentages (p < 0.01). ROC analysis showed FO (area under the curve (AUC) = 0.72) and PRISM-III (AUC = 0.97) as strong mortality predictors. Multivariable regression identified 24 hours and overall cumulative FO and PRISM-III score as independent predictors of mortality. Conclusion Twenty-four-hour cumulative FO is a significant determinant of mortality in critically ill children, emphasizing the need for early monitoring and targeted management strategies in PICUs.