Observational studyBMJ open2020
Dose-response association between fluid overload and in-hospital mortality in critically ill patients: a multicentre, prospective, observational cohort study.
Observational study in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 23 citations in OpenAlex.
- Perioperative fluid accumulation and clinical outcomes after cardiac surgery: a systematic review and Bayesian meta-analysis.Journal of anesthesia, analgesia and critical care · 2026Review
- C-Reactive Protein-Triglyceride Glucose Index and Mortality in Patients with Ventricular Septal Rupture After Acute Myocardial Infarction.Journal of inflammation research · 2026Article
- Association between fluid balance trajectories and prognosis in older patients with malnutrition: a group-based trajectory model analysis.Frontiers in nutrition · 2026Article
- Joint trajectories of nutritional risk and fluid balance and prognosis in critically ill adults: a dual-trajectory modeling study using MIMIC-IV and eICU.Frontiers in nutrition · 2026Article
- Subphenotyping sepsis based on organ interaction trajectory using a deep temporal graph clustering model: a retrospective cohort study.EClinicalMedicine · 2025Article
- Association of fluid balance index with in-hospital mortality in critically ill patients with acute pancreatitis: a multicenter retrospective cohort study.World journal of emergency medicine · 2025Article
- Nonlinear association between hematocrit levels and short-term all-cause mortality in ICU patients with acute pancreatitis: insights from a retrospective cohort study.BMC gastroenterology · 2025Article
- The Correlation of Fluid Creep with Fluid and Electrolyte Imbalance In Pediatric Intensive Care Unit Dr. Cipto Mangunkusumo National Central Public Hospital.Turkish archives of pediatrics · 2024Article
- Point-of-care ultrasonography spotlight: Could venous excess ultrasound serve as a shared language for internists and intensivists?World journal of critical care medicine · 2024Review
- Microcirculatory tissue oxygenation correlates with kidney function after transcatheter aortic valve implantation-Results from a prospective observational study.Frontiers in cardiovascular medicine · 2023Article
- Goal directed fluid removal with furosemide versus placebo in intensive care patients with fluid overload: A trial protocol for a randomised, blinded trial (GODIF trial).Acta anaesthesiologica Scandinavica · 2022Article
- Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis.Annals of intensive care · 2022Review
- A Positive Fluid Balance in the First Week Was Associated With Increased Long-Term Mortality in Critically Ill Patients: A Retrospective Cohort Study.Frontiers in medicine · 2022Article
- Assessment of Fluid Status by Bioimpedance Analysis and Central Venous Pressure Measurement and Their Association with the Outcomes of Severe Acute Kidney Injury.Medicina (Kaunas, Lithuania) · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesFluid management is important in ensuring haemodynamic stability in critically ill patients, but can easily lead to fluid overload (FO). However, the optimal fluid balance plot or range for critically ill patients is unknown. This study aimed to explore the dose-response relationship between FO and in-hospital mortality in critically ill patients.
designMulticentre, prospective, observational study.
settingEighteen intensive care units (ICUs) of 16 tertiary hospitals in China.
participantsCritically ill patients in the ICU for more than 3 days. PRIMARY OUTCOME MEASURES AND ANALYSES: FO was defined as the ratio of the cumulative fluid balance (L) and initial body weight (kg) on ICU admission, expressed as a percentage. Maximum FO was defined as the peak value of FO during the first 3 days of ICU admission. Logistic regression models with restricted cubic splines were used to explore the pattern and magnitude of the association between maximum FO and risk of in-hospital mortality. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score on admission, main diagnosis on admission to ICU, comorbidities, time of maximum FO, mechanical ventilation, renal replacement therapy, use of vasopressors and centres were adjusted in multivariable analysis.
resultsA total of 3850 patients were included in the study, 929 (24.1%) of whom died in the hospital. For each 1% L/kg increase in maximum FO, the risk of in-hospital mortality increased by 4% (adjusted HR (aHR) 1.04, 95% CI 1.03 to 1.05, p<0.001). A maximum FO greater than 10% was associated with a 44% increased HR of in-hospital mortality compared with an FO less than 5% (aHR 1.44, 95% CI 1.27 to 1.67). Notably, we found a non-linear dose-response association between maximum FO and in-hospital mortality.
conclusionsBoth higher and negative fluid balance levels were associated with an increased risk of in-hospital mortality in critically ill patients. TRIAL REGISTRATION NUMBER: ChiCTR-ECH-13003934.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.