Association of fluid balance index with in-hospital mortality in critically ill patients with acute pancreatitis: a multicenter retrospective cohort study.

IF 3.2 3区医学 Q1 EMERGENCY MEDICINE

World journal of emergency medicine Pub Date : 2025-09-01 DOI:10.5847/wjem.j.1920-8642.2025.102

Xiaodong Huang, Zhihong Xu, Siyao Liu, Xiong Liu, Long Lin, Mandong Pan, Xianwei Huang, Jiyan Lin

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引用次数: 0

Abstract

Background: Fluid resuscitation in acute pancreatitis (AP) patients requires precise titration because both excess and insufficient volumes may worsen outcomes. This study aimed to develop a weight-normalized fluid balance index (FBI) and assess its association with in-hospital mortality in critically ill AP patients.

Methods: This retrospective cohort study utilized data from the MIMIC-IV 3.0 database and the emergency intensive care unit (EICU) of our hospital (validation cohort) and was based on inclusion and exclusion criteria. Using the R package cutoff, an FBI of 145 mL/kg was identified as the optimal risk stratification threshold. The primary outcome was in-hospital all-cause mortality. Machine learning was used to screen covariates for inclusion in multivariable Cox models. Cox regression and restricted cubic spline (RCS) models were used to evaluate the relationship between FBI and mortality. Propensity score matching (PSM) was applied to minimize baseline confounding. After PSM, Kaplan-Meier survival curves were generated, and the results were validated via data from our center.

Results: In this study, 547 AP patients from the MIMIC-IV database and 156 from the EICU of our hospital were included. In the MIMIC-IV cohort, the overall in-hospital mortality rate was 8.96%. Patients with FBI ≥145 mL/kg had significantly higher in-hospital mortality than did those with FBI <145 mL/kg (P<0.05). High-risk classification remained an independent predictor of death after full adjustment (hazard ratio [HR] 1.99, 95% confidence interval [95% CI]: 1.08-3.69). Post-PSM Kaplan-Meier analysis confirmed significantly higher in-hospital mortality in the high-risk group (P<0.05). This result was corroborated by our validation cohort. RCS analysis further demonstrated a non-linear increase in in-hospital mortality with increasing FBI values.

Conclusion: An FBI ≥145 mL/kg may be associated with increased in-hospital mortality in critically ill AP patients.

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急性胰腺炎重症患者体液平衡指数与住院死亡率的关系：一项多中心回顾性队列研究

背景：急性胰腺炎（AP）患者的液体复苏需要精确的滴定，因为过量和不足的容量都可能使结果恶化。本研究旨在建立体重标准化体液平衡指数（FBI），并评估其与危重AP患者住院死亡率的关系。方法：采用回顾性队列研究，数据来自MIMIC-IV 3.0数据库和我院急诊重症监护病房（EICU）（验证队列），采用纳入和排除标准。使用R包临界值，145 mL/kg的FBI被确定为最佳风险分层阈值。主要终点是院内全因死亡率。机器学习用于筛选协变量以纳入多变量Cox模型。采用Cox回归和限制性三次样条（RCS）模型评价FBI与死亡率的关系。倾向评分匹配（PSM）用于最小化基线混淆。PSM后生成Kaplan-Meier生存曲线，并通过本中心数据对结果进行验证。结果：本研究纳入了MIMIC-IV数据库中的547例AP患者和我院EICU的156例AP患者。在MIMIC-IV队列中，总体住院死亡率为8.96%。FBI≥145 mL/kg患者的住院死亡率显著高于FBI PHR[1.99, 95%可信区间[95% CI]: 1.08-3.69)。psm后Kaplan-Meier分析证实高危组住院死亡率显著增高（结论：FBI≥145 mL/kg可能与危重AP患者住院死亡率增高相关）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World journal of emergency medicine EMERGENCY MEDICINE-

CiteScore

2.50

自引率

28.60%

发文量

671

期刊介绍： The journal will cover technical, clinical and bioengineering studies related to multidisciplinary specialties of emergency medicine, such as cardiopulmonary resuscitation, acute injury, out-of-hospital emergency medical service, intensive care, injury and disease prevention, disaster management, healthy policy and ethics, toxicology, and sudden illness, including cardiology, internal medicine, anesthesiology, orthopedics, and trauma care, and more. The journal also features basic science, special reports, case reports, board review questions, and more. Editorials and communications to the editor explore controversial issues and encourage further discussion by physicians dealing with emergency medicine.