Association Between Fluid Overload and Pressure Injuries in ICU Patients With Sepsis: A Retrospective Cohort Study

AIMS: To explore the association between fluid balance and the occurrence of pressure injury in patients with sepsis during ICU stay. DESIGN: Retrospective cohort study. METHOD: Patients were categorised based on cumulative fluid balance percentage: fluid negative balance (< 0%), neutral fluid balance (≥ 0% and ≤ 10%), and fluid overload (> 10%). Cox proportional hazard regression models were used to assess the associations between fluid balance and pressure injury occurrence. RESULTS: A total of 10,669 patients with sepsis were included, 2346 (22.0%) developed pressure injuries. Patients with pressure injury had higher cumulative fluid balance within the first 3 days. In multivariable models, fluid overload on Days 1, 2, and 3 after admission was independently associated with a higher hazard of pressure injury occurrence during ICU stay, with hazard ratios of 1.30, 1.30, and 1.39, respectively. CONCLUSIONS: Fluid overload occurs in 21.7% of patients with sepsis by day 3 of ICU admission and is independently associated with a higher hazard of pressure injury occurrence. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Integrating fluid management into nursing practice may support earlier identification and prevention of pressure injuries in the ICU. IMPACT: This study examines the association between cumulative fluid balance and pressure injury occurrence in patients with sepsis during ICU stay. The findings may inform ICU nursing practice and pressure injury prevention strategies. REPORTING METHOD: Following STROBE guideline: PATIENT OR PUBLIC CONTRIBUTION: This study utilised data from the Medical Information Mart for Intensive Care-IV 3.0 database. TRIAL AND PROTOCOL REGISTRATION: This retrospective study used the publicly available database and did not require trial registration.