ArticleEuropean journal of medical research2025
Association between serum osmolality trajectories and mortality in sepsis patients: a retrospective multi-cohort study.
Article in European journal of medical research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
backgroundSepsis commonly leads to fluid and electrolyte imbalances, often reflected in abnormal serum osmolality. Although static measurements of osmolality have been investigated, the prognostic significance of dynamic changes in serum osmolality over time remains poorly understood in patients with sepsis.
methodsWe conducted a comprehensive analysis of 22,737 septic patients from the MIMIC-IV and eICU-CRD databases, with external validation performed using an independent cohort of 303 patients from Zhejiang Provincial People's Hospital. Latent class trajectory modeling was applied to identify distinct patterns of serum osmolality during the first 4 days in the ICU. The association between trajectory patterns and mortality was assessed using Cox proportional hazards regression. Mediation analysis was employed to explore potential biological mechanisms, while parametric g-formula simulations were used to evaluate the impact of trajectory-specific fluid management strategies.
resultsThree distinct serum osmolality trajectories were identified: stable (ST), ascending (AS), and descending (DS). Compared to the ST group, both the AS and DS groups were associated with significantly higher 28-day mortality (HR 1.80, 95% CI 1.61-2.01 for AS; HR 1.83, 95% CI 1.62-2.06 for DS). Mediation analysis indicated that renal dysfunction (accounting for 11.16% of the total effect, P < 0.001) and cumulative positive fluid balance (11.39%, P < 0.001) partially mediated the observed associations. Parametric g-formula simulations revealed substantial heterogeneity in responses to fluid management across trajectory groups, with optimal fluid strategies varying significantly by trajectory pattern and patient characteristics.
conclusionDynamic serum osmolality trajectories are independent predictors of mortality in sepsis, with effects partially mediated through renal dysfunction and fluid imbalance. These findings support the implementation of trajectory-guided precision fluid therapy as a novel framework for individualized sepsis care, challenging one-size-fits-all approaches and offering evidence-based guidance for personalized treatment strategies.
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.