ArticleClinics (Sao Paulo, Brazil)2026
Correlation between early cumulative fluid balance and 90-day all-cause mortality in patients with acute pancreatitis: a retrospective cohort study.
Article in Clinics (Sao Paulo, Brazil), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveAggressive early hydration is the cornerstone of Acute Pancreatitis (AP) care, but the optimal fluid-balance strategy and its impact on long-term survival remain unclear. The authors therefore tested whether first-week fluid accumulation affects 90-day mortality.
methodsRetrospective cohort study of 1142 AP patients admitted to the Intensive Care Unit (ICU) within the MIMIC-IV database. Daily fluid intake/output were extracted for the first 7-days; patients were classified as cumulative positive (n = 842) or negative (n = 300) balance by Day-7. The authors used Cox regression, Propensity Score Matching (PSM), and multiple sensitivity analyses to evaluate the association between fluid balance and 90-day mortality.
resultsOverall 90-day mortality was 19.3%. Mortality was higher in the positive balance group. Multivariable Cox regression showed an adjusted hazard ratio (HR = 1.54 [1.06-2.22], p = 0.022); the corresponding E-value was 2.45. After PSM, the association persisted. IPTW yielded a similar point estimate (HR = 1.51, 95% CI 1.01-2.25, p = 0.115). Landmark analyses excluding early deaths confirmed the finding. RCS revealed a non-linear relationship, suggesting both highly positive and negative balances are associated with increased mortality.
conclusionA positive cumulative fluid balance at Day-7 is associated with increased 90‑day mortality in ICU patients with AP. This association may partially reflect the higher severity of the underlying disease process in the group with positive cumulative fluid balance on Day-7, rather than a direct causal effect. Despite this limitation, the present findings support an individualized, biphasic fluid strategy: early adequate resuscitation followed by goal‑directed de‑escalation.
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