Xiaodong Huang, Zhihong Xu, Siyao Liu, Xiong Liu, Long Lin, Mandong Pan, Xianwei Huang, Jiyan Lin
{"title":"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","authors":"Xiaodong Huang, Zhihong Xu, Siyao Liu, Xiong Liu, Long Lin, Mandong Pan, Xianwei Huang, Jiyan Lin","doi":"10.5847/wjem.j.1920-8642.2025.102","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>P</i><0.05). High-risk classification remained an independent predictor of death after full adjustment (hazard ratio [<i>HR</i>] 1.99, 95% confidence interval [95% <i>CI</i>]: 1.08-3.69). Post-PSM Kaplan-Meier analysis confirmed significantly higher in-hospital mortality in the high-risk group (<i>P</i><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.</p><p><strong>Conclusion: </strong>An FBI ≥145 mL/kg may be associated with increased in-hospital mortality in critically ill AP patients.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"462-468"},"PeriodicalIF":3.2000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444246/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association of fluid balance index with in-hospital mortality in critically ill patients with acute pancreatitis: a multicenter retrospective cohort study.\",\"authors\":\"Xiaodong Huang, Zhihong Xu, Siyao Liu, Xiong Liu, Long Lin, Mandong Pan, Xianwei Huang, Jiyan Lin\",\"doi\":\"10.5847/wjem.j.1920-8642.2025.102\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>P</i><0.05). High-risk classification remained an independent predictor of death after full adjustment (hazard ratio [<i>HR</i>] 1.99, 95% confidence interval [95% <i>CI</i>]: 1.08-3.69). Post-PSM Kaplan-Meier analysis confirmed significantly higher in-hospital mortality in the high-risk group (<i>P</i><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.</p><p><strong>Conclusion: </strong>An FBI ≥145 mL/kg may be associated with increased in-hospital mortality in critically ill AP patients.</p>\",\"PeriodicalId\":23685,\"journal\":{\"name\":\"World journal of emergency medicine\",\"volume\":\"16 5\",\"pages\":\"462-468\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444246/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World journal of emergency medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5847/wjem.j.1920-8642.2025.102\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World journal of emergency medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5847/wjem.j.1920-8642.2025.102","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
Association of fluid balance index with in-hospital mortality in critically ill patients with acute pancreatitis: a multicenter retrospective cohort study.
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.
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.
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